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The Journd
of the
tridine TTledicdl Associdtion
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MAINE MEDICAL ASSOCIATION
The ninetieth Annual Session luill be held at
The Poland Spring House, Poland Springs, Hlaine
June 21, 22, 23, 1942
Volume Thirty-three
January, 1942
Number One
imPORTAnT — A Call to the Kledical Profession ^ Page 14
• The strictly regulated program of the
Army helps to harden the soft, lackadaisical
rookie. But what about the men who remain
in civilian life?
When the deleterious effect of a soft civil-
ian life — irregular habits, lack of exercise,
faulty diet — leads to constipation, the use of
Petrogalar* is frequently indicated.
Petrogalar adds bland, unabsorbable mois-
ture to the stool to induce a soft, easily
passed mass.
Consider its use for the treatment of con-
stipation. Petrogalar is pleasant to take and
economical to use.
FOR THE TREATMEIVT OF CONSTIPATION
Petrogalar
*Trade Mark. Petrogalar is an aqueous suspension of pure mineral
oil each 100 cc.of which contains 65 cc.pure mineral oil suspended
in an aqueous jelly containing agar and acacia.
Petrogalar Laboratories, Inc. • 8134 McCormick Boulevard • Chicago, Illinois
The Journdl
of the
Maine Medical Associdtion
Uolume Thirtij ''three Portland, TUaine, Januan^, 1942 No. 1
'^Medical Queries Answered
Symposium Conducted by Howaed T. Kaeseer, M. D., Joseph H. Peatt, M. D.,
William B. Dameshek, JI. D.
Edited by J. Gottlieb, M. D.
QUESTIOiSr : A patient enters the hos-
pital in a comatose condition — ivhat labora-
tory examinations do you feel are necessary
to he carried out on such a patient f
AbfSAYERS :
De. Pratt : One would first think of dia-
betic coma or uremia, and an examination of
the urine ( catheter ized specimen) would be
in order. If I found sugar in the urine, I
would at once have an examination of the
blood for sugar; if however, there Avas no
sugar, and the patient had albumin, casts,
and the specific gravity was low, it would be
very suggestive of uremia and I would want
to determine the IST. P. IST. With the specific
gravity between 1.010 and 1.012, I would
make a tentatiAm diagnosis of uremia ; if the
urine were normal and showed no sugar.
Dr. Dameshek : The first thing to do of
course is to try to get a history, then do a
physical examination. The laboratory pro-
cedures Avould then depend upon the physical
findings — if there was alcohol on the breath,
I Avouldn’t do very much laboratory AA^ork. If
there was a stiff neck, or signs of paralysis, a
lumbar puncture Avould be indicated. Other
procedures depend upon the findings. If the
findings were minimal and we see a man
comatose with no stiff* neck or sigTis of paraly-
sis, a specimen of urine should immediately
be taken and if diabetes Avere discovered, a
blood sugar and a blood CO2 combining
power might well be done. One other labora-
tory procedure that might not be amiss, par-
ticularly in shock, is that of blood typing.
De. Karsnee : I am firmly of the opinion
that the determination of what laboratory
tests should be done should rest Avith the clini-
cian. As concerns emergency tests in a hos-
pital, the decision should be arrived at by con-
ference betAveen clinician and laboratory
man. Each institution probably has its OA\m
problems in this connection, but in our own
hospital we recognize as emergency proced-
ures, white blood cell counts, hemoglobin and
red blood cell counts, blood typing, cross
matching and the Kline test for emergency
transfusions, blood sugar, carbon dioxide
combining poAver, non-protein nitrogen and
urea in the blood, pneumococcus typing by the
Keufeld method, determination of quantities
* Prom the Central Maine General Hospital Teaching Clinic, September 5, 1941.
2
of sulfonamide drugs and in certain circum-
stances where it is desired to coordinate bac-
terial cultures with the time of a chill, we
recognize such blood cultures as emergencies.
Dr. Gottlieb : The question has already
been adequately answered. A large number
of laboratory examinations have been men-
tioned and I trust that no one interprets this
list as essential in each case admitted in the
state of coma and proceeds to order all these
on the theory of being thorough. This is a
tendency that has been developed by fortu-
nately only a few clinicians and in my
opinion indicates a lack of understanding of
the value of these tests and even a lesser
knowledge of the particular problem present-
ing itself. As has already been pointed out,
each case will demand one or a few of the
examinations, but at no time all of them on
a blanket order. The closer the clinical im-
pression to the correct diagnosis, the fewer
will be the tests required.
Dr. Hiebert: How often should these
things be repeated after the first examina-
tion ?
Dr. Dameshek: If it is a diabetic coma,
it may be necessary to study the blood sugar
every three to four hours, or even more fre-
quently.
QIJESTIOH : Is a blood sugar examinob-
tion of more or less importance than a uri-
nalysis ?
ANSWERS:
Dr. Pratt : I would say that the urinary
examination was of more importance.
Dr. Dameshek: I have handled cases of
diabetic coma in the home, with examination
of the urine alone. It may be a bit risky, but
it can be done.
Dr. Gottlieb : A single urinalysis is sim-
pler to perform and gives more information
than a single blood sugar determination. It
tells us what has been happening over a
period of hours, rather than what exists at
the particular moment when a blood sugar is
taken, and for these reasons, I would choose
a urinalysis in preference to a blood sugar de-
termination. Moreover, a blood sugar deter-
mination can only be performed, generally,
The Journal of the Maine Medical Association
in a hospital laboratory ; a procedure which is
difficult to repeat outside of the institution
where the patient is expected to live the
greater part of his life, and during which
period the patient is expected to follow his
diabetic treatment on the basis of his urinary
findings. If that much is expected of the pa-
tient, it is not too much to expect of the physi-
cian. I grant that during the hospital stay
and during the period of stabilization, blood
sugars are undoubtedly of great value and in
questionable cases of diabetes, blood sugars
performed for sugar tolerance determination
often determine whether the patient is dia-
betic or not.
Dr. Karsher: Time may well be saved if
the doctor himself examines the urine. Hat-
urally the determination of blood sugar is
within the province of the laboratory.
QUESTION : What is the relation be-
hveen extensive laboratory requests and basic
clinical knowledge ?
ANSWERS:
Dr. Karsxer: One of the difficulties of
our times is the danger of establishing what
a former assistant described as ‘Gash register
medicine.” He meant by this, the accumula-
tion of data on the basis of many different
laboratory tests and the attempt to make a
diagnosis on the basis of these tests. This
method leaves out of account basic clinical
knowledge and basic clinical diagnostic pro-
cedures and is likely to do harm to the inti-
macy of contact that should exist between
physician and patient.
Dr. Dameshek : The more you know about
medicine, the fewer laboratory tests you per-
form. By and large, a doctor cannot make a
diagnosis simply by carrying out a lot of
laboratory tests and then doing the proper
adding and subtracting. The diagnosis is usu-
ally made by a careful history and physical
examination and by doing a few laboratory
tests as indicated. Too many basal metabo-
lisms, too many electrocardiograms, too many
X-rays add up the expense to the patient and
in a majority of cases are needless.
Dr. Karsner: I believe that the highest
compliment I can pay anyone is to say that
Nineteen Hundred and Forty-two — January
he is a good doctor. My idea of a good doc-
tor, however, is not one who will devote his
principal attention to determining what lab-
oratory tests can be done. He must make his
clinical study of the patient the basis of all
other work with that patient. Because of the
fact that certain doctors and a good many of
the large clinics perform a great many lab-
oratory tests, patients have sometimes come
to expect that on the part of their doctors.
This seems to be because a patient who has
had many laboratory tests thinks that it is a
great accomplishment and boasts of the fact
to his friends. I am certain that a competent
physician can convince his patients that his
clinical study is basic and that he determines
the laboratory tests that are necessary to es-
tablish his diagnosis. It is of course shameful
to report that occasionally doctors ask for a
large number of laboratory tests, not so much
for the study of the case as apparently for
the sake of making an impression on their
patients.
De. Pratt: I have been impressed with
the neglect of physical diagnosis ; especially
in diseases of the chest. Our younger physi-
cians are apt to place too little stress on care-
ful palpation and auscultation. They are all
too eager to have an X-ray of the chest, and
in a large number of cases, an X-ray exami-
nation of the chest is unnecessary.
Dr. Dameshek : There is one thing a]x)ut
laboratory tests. If you yourself have done a
great many laboratory tests, then you are bet-
ter able to discriminate which patient needs
what tests. If you yourself have done a good
many blood counts, you can tell in which case
a blood count is not necessary, or what par-
ticular count is necessary.
QUESTIOX : What is the lowest level of
red hlood cells and hemoglobin compatible
with life?
AXSWERS :
Dr. Dameshek : If you have 5,000,000
red blood cells and 90% hemoglobin and sud-
denly lose one-half this concentration at the
age of 60, you may die very quickly, but if
you start with the same number and gradu-
ally become anemic over a period of a year,
you may get along very well. The lowest
3
possible level is perhaps 500,000 red blood
cells and a hemoglobin of 12-15. In per-
nicious anemia, counts of 30% hemoglobin
with 700,000 red cells are not uncommon.
With a bleeding peptic ulcer and a red blood
count of 700,000, the hemoglobin would be so
low as to be practically incompatible with
life.
De. Gottlieb : I might point out that im-
mediately following an acute hemorrhage, no
matter how extensive, a red cell or hemo-
globin determination is practically of no
value. There is neither a fall in the red cells
nor in the hemoglobin. This becomes obvious
when one thinks of the fact that red cells and
hemoglobin are measured in terms of cubic
millimeters and that despite the fact that per-
haps half of the blood volume may have been
lost, the concentration of the remaining 50%
is exactly the same. Therefore, an emergency
call for a red blood cell count immediately
after hemorrhage has no meaning whatsoever.
QUESTIOX : Is digitalis indicated in
myocardial failure due to coronary occlusion?
AXSWEES:
Dr. Pratt: Xo.
De. Karsner : It seems illogical to me.
Dr. Dameshek : Don’t some cases get
right sided failure and congestion of the liver
— isn’t it good then ? But in left sided ven-
tricular failure it wouldn’t be useful. If a
patient develops rales, it might be worth
while.
Dr. Goodwin: Following an acute coro-
nary where the heart is rapid and irregular,
what would you use ?
Dr. Pratt : I think opium in acute heart
failure is the most valuable drug to employ.
Dr. Dameshek : In the case of coronary
thrombosis with irregTilar, rapid heart action,
quinidine may be very helpful, and may even
prevent dreaded ventricular fibrillation.
QUESTIOX : What is a simple, rapid
and effective serological test that may be per-
formed on blood donors which may be carried
out ivhile they are being typed?
4
Al^SWEES :
Dr. Karsneb : The Kline test.
Dr. Gottlieb: We do it here because of
its simplicity and accuracy.
QUESTION : What are the effects if any,
of inhaling hydrogen sulfide over a period of
weehsf
ANSWERS:
Dr. Dameshek : Is the Androscoggin
River a source of hydrogen sulfide? The
eifects of this chemical depend upon the con-
centration. The concentration in Lewiston
can’t really be very great, or there would he
a great deal of nausea aggravated by psycho-
genic factors. Whether it has any effect other-
wise, such as in the development of
sulphemoglobinemia is very, very doubtful.
Aesthetically, of course, the odor is by no
means desirable.
Dr. Hiebert : The hospital patients feel
that it does them harm, especially the pa-
tients with tuberculosis, and the psychology
factor is important.
Dr. Karsner: I do not know of any in-
formation as to the effects on the form or
function of the body produced directly by the
inhalation of such amounts of hydrogen sul-
fide as may be present in the atmosphere.
Certainly there is a psychological factor that
may well be underestimated.
QUESTION : Is oxygen of any value in
congestive heart failure?
ANSWERS:
Dr. Pratt : I should say that there is a
distinct value in making the patient more
comfortable.
Dr. Gottlieb : How would you explain
the mechanism ?
Dr. Pratt: I don’t know, but if I saw a
patient in distress, I would try it empirically.
Dr. Steele : I think it makes the patient
more comfortable ; they take up more oxygen
in the tissues and there is apt to be edema of
the alveolar walls and diffusion of the gas in
the tissues.
The Journal of the Maine Medical Association
Dr. Gottlieb : Is it reasonable to assume
that they take up more oxygen that way than
by air alone ?
Dr. Karswer: There is no particular rea-
son for believing that the amount of oxygen
in the air determines the capacity of the
blood, either of the plasma or the cells, in the
absorption of oxygen. Nevertheless, there
may be a failure of absorption principally
because of the fact that in congestive failure,
the rate of blood flow through the lungs is
reduced. That would mean an inadequate
absorption of the oxygen in the atmosphere
that might well be corrected if the concentra-
tion of the oxygen of the air inhaled into the
lungs were increased by the use of the tent
or the catheter. Even the enlargement of the
capillaries the result of passive hyperemia
does not appear to furnish sufficient area of
absorption to compensate for the stagnation
of the blood current. The influence of edema
within the alveoli is not well understood. It
is possible, however, as suggested by Hoover
many years ago, that this interferes with the
absorption of oxygen less than it interferes
with the diffusion of carbon dioxide. Thus,
one of the most serious factors in congestive
failure is the accumulation of carbon dioxide
in the blood.
QUESTION : Does hcicterial endocarditis
presuppose a history of rheumatic disease ?
ANSWERS :
Dr. Karsxer: This question must be
separated as concerns acute bacterial endo-
carditis and endocarditis lenta, or subacute
bacterial endocarditis. It is certainly true
that acute bacterial endocarditis may be im-
planted upon a valve that is otherwise nor-
mal. How much the presence of rheumatic
disease determines the development of acute
bacterial endocarditis is not known, but cer-
tainly from our own data it would appear
that acute endocarditis occurs more fre-
quently in hearts the seat of other disease
than if they were normal. This would not
apply to such violent acute forms of endocar-
ditis as those observed with pneumococcal and
gonococcal infections. In my own experience,
I have never seen a case of subacute bacterial
endocarditis implanted on an otherwise nor-
Nineteen Hundred and Forty-two — January
mal valve. There are reports of occasional
instances of this sort. It may well be that as
pathologists learn more readily to distinguish
the stigmata of rheumatic heart disease, this
incidence will be reduced. It is said that
subaciiate bacterial endocarditis is implanted
upon syphilitic disease of the aortic valves.
My associate, Dr. Koletsky, has examined five
hearts in which it was supposed that subacute
bacterial endocarditis was implanted on
syphilitic valvular disease. Critical examina-
tion, however, showed that four of these
hearts were also the seat of rheumatic disease.
This raises the question as to whether or not
endocarditis lenta is ever implanted on a
valve the seat of syphilitic disease only.
Dr. Gtottlieb : I saw a two-year-old child
with acute vegetative endocarditis staphylo-
coccus showing no other cardiac pathology or
congenital abnormalities. One case of pneu-
mococcie endocarditis was also on an other-
wise normal valve, in a youngster six years
old.
Dr. Karsner : Congenital cardiac defects
undoubtedly predispose to endocarditis. Ex-
amination shows that there is a variable
amount of fibrosis. It is possible, therefore,
that the fibrosis determines the occurrence of
tlie endocarditis rather than the congenital
defect itself.
QUESTIOlSr : Which of the liver func-
tion tests are most informative?
AIISWERS :
Dr. Dameshek : It is always nice to know
if the patient is jaundiced and how much.
The bilirubin test is in a sense an indication
of liver function ; the more bilirubin in the
blood, the worse the liver is. In very mild
cases of jaundice, one suspects the possibility
of cirrhosis of the liver. The excretion tests
are generally better in these cases than the
other tests. Eor example, the bromsulphalein
excretion test is better here than determina-
tion of the cholesterol esters, though the lat-
ter may be superior in cases of mild or moder-
ate jaundice. The most sensitive excretion
test is that of bilirubin excretion. In this
test the same substance is injected into the
circulation which the liver excretes normally,
and if it piles up in the blood, there is good
evidence of hepatic dysfunction. Thus, if
you want to determine the matter of liver
dysfunction it should be remembered that
you may have to do as many as a half dozen
tests before coming to a conclusion.
Dr. Pratt : The liver has many functions
and there is no test that is wholly satisfactory.
Dr. Dameshek : The urinary urobilinogen
becomes increased in mild hepatic disease. If
there is a combination of bile in the urine
and increased urobilinogen, hepatic disease
is even more likely. If one performs both
urine and fecal urobilinogen tests, one’s
chances of making a definite conclusion are
more probable.
Dr. Gottlieb : I have seen numerous
tests within normal ranges in livers diffusely
infiltrated with carcinoma. In my experi-
ence, the dye tests are of little value. A
marked reduction of cholesterol esters is prac-
tically diagnostic of extensive liver cell dam-
age as seen in ‘^yellow atrophy.”
Dr. Karsher: ISTone of these tests is in
itself, diagnostic.
QUESTIOiSr : What is the differential
diagnosis between bronchial and cardiac
asthma?
AIISWERS:
Dr. Pratt : When seen in an attack, it
may be impossible to distinguish between
them. We get the same wheezing type of
breathing. The differential diagnosis depends
on the history and physical examination. We
know the clinical history of bronchial asthma
as a condition which may develop in early
life and last for many years. The cardiac
asthma rarely develops before the age of 50
and the patient may have hypertensive heart
disease, characterized by sudden onset and
dyspnea, with or without wheezing, in a pa-
tient who has never suffered from asthma
before. Attacks usually come on at night and
usually the patient is forced to sit upright,
and forced to go to an open window. It may
occur in a patient who has had no asthma be-
fore, and no shortness of breath previously.
Most of these patients die within two or three
years.
6
Dr. Greene: Why do these attacks occur
at night?
Dr. Pratt: They rarely occur until mid-
night or after, but the reason for this is not
clear.
Dr. Goodwin : Does cardiac asthma come
on with exertion?
Dr. Pratt: ISTo. Usually the patient is at
rest. It is a form of left ventricular failure
with pulmonary congestion. There are four
clinical types: (1) pure cardiac asthma; (2)
cardiac asthma with angina pectoris; (3)
cardiac asthma followed by pulmonary
edema; (4) dyspnea, pain and pulmonary
edema.
Dr. Dameshek : In treating cardiac
asthma, adrenalin may make the heart stop
instead of stimulating it. You should sit the
patient up in a chair, put tourniquets around
the arms and legs and then give your intra-
venous treatments. These patients want to
sit up. Put them in a chair and let their legs
hang down.
QUESTION : Is there any value in ad-
ministering liver extract in so-called second-
ary or hypochondriac anemia'^
ANSWER:
Dr. Dameshek: No, there is not. These
patients have an iron deficiency, and all they
require is iron. Liver extract is a waste of
the patient’s money.
QUESTION : What is the relation be-
tween angina pectoris and coronary occlu-
sion?
ANSWERS :
Dr. Pratt: Many cases of severe angina
pectoris are due to occlusion of a small
branch of a coronary artery. Both are dis-
eases of the coronary artery, resulting in
anoxemia of the heart muscle.
Dr. Karsner: It is now generally ac-
cepted that the symptoms of angina pectoris
depend on anoxemia of the myocardium.
This may be an anoxemia due to obliterative
disease of the coronary arteries or it may be
a relative anoxemia in which the work of the
heart is in excess of the capacity of the coro-
The Journal of the Maine Medical Association
nary circulation. Autopsies on cases of an-
gina usually show coronary sclerosis and
there are but few cases reported in which this
is not true. It seems to me that it is im-
possible to make a differential diagnosis be-
tween angina and coronary occlusion without
study of the electrocardiogram but it must be
admitted that this is not a final and absolute
criterion because even in cases of myocardial
infarction the electrocardiogram may not
show any material disturbance.
Dr. Pratt: There are a great many indi-
viduals who have mild angina on slight exer-
tion in which the electrocardiogram is
normal. In any case of severe angina, an
electrocardiogram should be made.
Dr. Karsner: Patients also may have
coronary occlusion with little or no pain.
Dr. Goodwin : Those who do not have
pain do have a sense of pressure that doesn’t
amount to pain.
Dr. Pratt : Substernal pressure on exer-
tion is of diagnostic significance in angina.
Dr. Goodwin : Does nitro-glycerin give
you any clue ?
Dr. Pratt: If nitro-glycerin gives relief
it tends to confirm the diagnosis of angina.
Dr. Dameshek : Angina pectoris is a
symptom and usually of coronary disease.
The term coronary thrombosis might well be
dropped as a clinical diagnosis, when what
we really mean is myocardial infarction,
which may or may not be due to coronary
occlusion.
Dr. Karsner: Your patient who has pres-
sure and no pain — does it come on exertion ?
Dr. Goodwin : It comes on with exertion.
Dr. Gottlieb : I have seen many cases of
coronary occlusion in which the electrocardio-
grams were normal. In one case there were
fourteen lesions, each occluding a coronary
branch and yet the electrocardiograph trac-
ings were all within normal range at various
times. Often electrocardiograms indicating
occlusion become negative subsequent to the
healing process of the myocardium distal to
the occlusion with or without recanalization
of the vessels. If an occlusion occurs as a
slow, progressive process permitting oppor-
Nineteen Hundred and Forty-two — January
tunitj for the establishment of a collateral
circulation, the electrocardiographic tracing
will at no time show any evidence of the
occlusion. Of course, acute occlusion is regu-
larly mirrored in the tracing not because of
the occlusion, but because of the distally in-
farcted myocardium.
QUESTION : Is coronary occlusion most
likely to occur during effort or rest?
ANSWEES :
Dr. Dameshek: You can frequently dig
up a history of violent exertion or excitement.
Dr. Gottlieb : I am certain that the ma-
jority of occlusions occur during rest. In the
case mentioned above all the lesions subse-
quent to the first few occurred during the
patient’s stay at the hospital. Statistically the
gTeatest incidence is in the early morning
hours before rising.
QUESTION : Is the prognosis better or
worse in coronary occlusion in the presence of
cardiac hypertrophy ?
ANSWEES :
Dr. Karsner : It is not as good.
Dr. Steele : I agree that it is not as good.
Dr. Karsxer : The cardiac hypertrophy
in cases of coronary disease is due to some
factor which increases blood pressure, such as
essential hypertension, or chronic renal dis-
ease. Studies in our Institute indicate clearly
that hypertrophy is likely to be greater in
hearts the seat of coronary sclerosis than in
hearts that show little or no such disturbance.
Unquestionably a heart the seat of hyper-
trophy has less reserve than a normal heart.
Thus the presence of hypertrophy is defi-
nitely unfavorable as to outlook.
Dr. Gottlieb : We have, I believe, worked
out a satisfactory technique for the study of
coronary volume in relation to the myocardial
mass. On the basis of the hearts studied it
may be deducted that the larger the heart
the greater the coronary bed. Eelatively, how-
ever, the larger heart is proportionately an-
oxemic and therefore suffers to a greater
degTee than a smaller heart whose circula-
tion is to begin with more efficient.
7
QUESTION : What is the relative prog-
nosis between anterior and posterior coronary
occlusion?
ANSWEES :
Dr. Pratt: I should think the prognosis
would depend in any case on the amount of
heart muscle that was involved in the infarct.
Dr. Steele: In a general way, if a per-
son survives the immediate episode, the scars
when they form are less likely to get cases of
cardiac failure and less cases of cardiac
asthma.
Dr. Pratt : Less of the posterior.
Dr. Karsker : It must be remembered
that the coronary supply to the posterior as-
pect at the base of the left ventricle varies.
Usually it comes from the left circumfiex
branch but quite frequently it also comes
from the terminals of the right coronary.
Dr. Gottlieb : The circulatory pattern is
of most importance. The type in which there
are free anastomosis at the intraventricular
septum offers the best prognosis.
Dr. Karsner: Jane Sands Eobb has given
a careful description of the arrangement of
cardiac muscle in spiral bundles. Of these,
the deep bulbo-spiral muscle which encircles
the mitral orifice is obviously of the utmost
importance. She has found experimentally
and on the basis of anatomical studies in man
that occlusion of the arterial supply to this
bundle is rapidly fatal. The data as to other
of the spiral bundles is not complete as yet.
Before any of this can be accepted, confirma-
tion must be obtained.
QUESTION : Of what consequence are
the small, thin, smooth-iu ailed cysts encoun-
tered in the ovary?
ANSWEE:
Dr. Karsher : Eetention cysts frequently
accompany the thickened capsule of the ova-
ries and can be confused with the pain of
appendicitis.
QUESTION : What procedure is indi-
cated in suspected Paget’s disease of the
nipple?
8
ANSWEE:
Dr. Karsjster: The well developed case of
Paget’s disease is one of carcinoma either of
the epidermis, the duct of the nipple, or both.
Ordinarily there is an associated carcinoma
of the mammary gland hut there are cases on
record in which metastasis to the axillary
lymph nodes has occurred without involve-
ment by carcinoma of the mammary gland.
Thus it would appear that carcinoma of the
nipple in the form of Paget’s disease is to be
managed as carcinoma anywhere else in the
breast. As a rule, the clinical diagnosis of
Paget’s disease is not exceedingly difficult.
ISievertheless, there are cases of eczema of the
nipple and of crusty nipple that may be con-
fusing. If the clinical diagnosis is really
doubtful, I think the diagnosis can be made
by biopsy of the nipple.
QUESTIOIST : ^Yllat is the relation of an
ovary to the development of endometrial
hyperplasia?
AIISWER:
Dr. Karsner: Hyperplasia of the endo-
metrium can be due either to disturbance of
circulation of the uterus due to malposition
or to overactivity of the ovary. In some cases
the production of an excess of internal secre-
tion of the ovary can be attributed to tumors,
such as the granulosa-cell tumor, but there
are certain cases in which the ovary shows no
microscopical lesion.
QUESTIOlSr : Hoiv can one differentiate
chemically a masculinizing tumor of the ad-
renal from one of the ovary? Is there any
relation hetioeen the tivo?
ANSWER:
Dr. Karsnee : Clinically the manifesta-
tions of both are similar if not identical. A
study of the output of androgenic substances
by Eriedgood in the Journal of Clinical In-
vestigation for July, 1941, indicates that in
the adrenal mascnlinizing tumors there is an
increased output of dehydroxylisoandroster-
one which ordinarily constitutes only a small
fraction of the androgen content of the urine.
That this will ever serve as a distinguishing
feature between tumors of the adrenal and
The Journal of the Maine Medical Association
tumors of the ovary, masculinizing in prop-
erty, is still uncertain.
QUESTION : What are the effects of
chemotherapy on kidney functioii — that is,
are the blood levels of uric acid, etc. elevated?
ANSWERS :
Dr. Dameshek : With the sulfonamide
drugs, one should always be on the lookout
for renal failure, for occasionally the tubules
become plugged up and the N. P. N would
then tend to go up.
Dr. Karsner: My associate. Dr. Joseph
M. Hayman, has shown that if the kidneys
are the seat of some insufficiency, the admin-
istration of the snlfonamide drugs leads to an
increased concentration of the drug in the
blood and also to augmentation of the renal
insufficiency. Thus, if time permits, a deter-
mination of renal function should be made.
QUESTION : Whal is the present status
of Colloidal Gold therapy in rheumatic arth-
ritis? Vaccines?
ANSWERS :
Dr. Dameshek : Colloidal Gold has been
given in many diseases, including tubercu-
losis, lupus erythematosus, and arthritis.
Disorders of the bone marrow may well de-
velop under treatment with this drug (leuko-
penia, anemia, thrombopenia). I personally
doubt that it has any real value in rheuma-
toid arthritis.
Dr. Pratt : I know of some cases of rheu-
matoid arthritis in which favorable results
have been obtained.
QUESTION : What is the ahnor7nal
physiology ivhich results in total collapse of
one or more lobes of the lung luith no evi-
dence of obstruction?
ANSWER:
Dr. Karsxer: The number of autopsies
on patients with massive pulmonary atelec-
tasis is so small that an anatomical back-
ground for the condition cannot be satisfac-
torily provided. Nevertheless there appears
to have been in some of these cases obstruc-
Continued on page 13
Nineteen Hundred and Forty-two — January
President s Address^'
President, Maine Hospital Association, Bangor, Maine.
Allan Craig, M. H.,
The past year has been one of national
anxiety and apprehension, which has been
reflected in every community and in every
institution throughout the country. Never has
such a world emergency faced our people in
every walk of life. The practical patriotism
of each citizen and each institution is being
put to test, and the period of strain is far
from over, in fact, we have but passed through
its preliminary phase. What the coming year
may bring to us none can foretell, but of one
thing I am sure ■ — - the hospitals of Maine
will not be found wanting in the performance
of their full duty to the people and the State
whom they serve.
This has been a legislative year in Maine,
and we in the hospital field and our people at
large have good reason to be grateful for the
consideration given ns by the Maine Legis-
lature and our new Governor. No doubt we
often fail to appreciate the difiiculties and
intricate problems which have to be met at
each session of our State Legislature. In-
creased appropriations for various purposes
are in constant demand. These increases in
time create a necessity for increased state
revenue, which frequently brings up the
problem of increased taxation, and then the
shoe pinches. It is apparent, therefore, that
unreasonable demands can not be given con-
sideration and must be eliminated, but sound
necessities for the welfare of our people can
not be overlooked, especially if they are ad-
equately demonstrated.
Your Legislative Committee this past year
first of all presented the hospital problem,
with relation to State Aided cases, to the
Commissioner of Health and Welfare, Mr.
Joel Ernest. Mr. Ernest was most consider-
ate and cooperative, with the result that the
request of the Committee for an increased
appropriation was included in the budget of
the Health and Welfare Department. The
problem was then presented to both the
Budget Committee and the Appropriations
Committee during their hearings and was
also placed before the Governor, with the
result that the State Aid appropriation was
increased from two hundred thousand dol-
lars j)er year to three hundred thousand.
It is our hope that this increase will help
to relieve the burden on our hospitals and
will also permit more hospitals to admit and
care for state-aided patients. It is well to
call to mind, at this time, that the hospital is
permitted to collect from the patient, in part
payments, or otherwise, the difference be-
tween what the State pays for state-aided
patients and $3.00 per day. A continuous
effort to make this extra collection will un-
questionably bring some results and should be
undertaken by the hospitals.
The problem of medical and surgical care
of state-aided patients is one which I feel
will have to be worked out by each individual
hospital and its medical staff. Many hospi-
tals have in their requirements for admission
to the medical staff a provision that each
member of the staff shall be responsible for
his due share of the free work of the insti-
tution.
During the hearing on the State Aid Ap-
propriation, it was amply demonstrated that
we in the hospitals of Maine are in need of
a more or less uniform system of accounting
in our institutions. May I draw to your
attention at the present time the fact that the
American Hospital Association has gotten out
a manual on Accounting for both large and
small hospitals. I would urge strongly that
each hospital procure a copy of this manual
and follow it as closely as possible. When
hospitals seek or accept public funds, they
must have a reliable means of demonstrating
business procedure and their handling of
expenses and income. There is no excuse for
any looseness or lack of organization in this
regard. I readily admit that accounting sys-
tems can be so intricate and cumbersome as
Continued on page 20
Presented at the annual meeting of the Maine Hospital Association, Lakewood, Maine, August 20,
1941.
10
The Journal of the Maine Medical Association
The More Common Chemical Values and Their Clinical Inter •
pretations Including Chemotherapeutic Levels
fBy Julius Gottlieb, M. D., F. A. C. P., and Milan Chapin, M. D., Ph. D.
'Normal
Ino’eased in
Decreased in
N. P. N.
25-40 mg. %
Renal Insufficiency
Metallic Poisoning (Hg.)
Dehydration
Prolonged Infectious Fever
Intestinal Obstruction
Hyperemesis
Adrenal Insufficiency
Hemorrhage (G. I. Tract)
Cardiac Failure
Coronary Thrombosis
Shock States
Diuresis
Diabetes Mellitus
Diabetes Insipidus
B. U. N.
10-15 mg. %
Same as above
Rises at a faster rate than N. P. N. in
Hepato-Renal Syndrome
Severe Hepatic Insufficiency
Eclampsia 15-40% of N. P. N.
Nephrosis
Low Protein Diet
Chronic Wasting Diseases
Amyloidosis
May be low in Pregnancy
Urea N:N. P. N.
0.35 — 0.50
Renal Insufficiency
Hepatic Insufficiency
Acute Yellow Atrophy
Poisoning (P, CCl^, CHCI3)
Eclampsia
Uric Acid
2-4 mg. %
Pregnancy (early rise in Toxemias)
Gout
Nephritis
Leukemia
Excessive Tissue Destruction (burns)
Poisoning (Pb., Hg.)
May be increased in Pneumonia, in the
Newborn, and in Starvation
Characteristic of Beginning Renal In-
sufficiency
Total Protein
6-8 gms. %
Multiple Myeloma
Lymphogranuloma Inguinale
Boeck’s Sarcoid
Dehydration
Kala Azar
Schistosomiasis
Acute Nephritis
Nephrosis with Inversed A-G Ratio
Severe Hepatic Insufficiency
Creatinine
1-2 mg. %
Last to Rise in Marked Renal Insuffi-
ciency
May be increased in Severe Intestinal
Obstruction of Pregnancy
Glucose
80-120 mg. %
Diabetes Mellitus
Hyperthyroidism
Early Acromegaly
Increased Intracranial Pressure
Infections
Hypothyroidism
Addison’s Disease
Pancreatic Adenoma or Carcinoma
of Islet Tissue
Late Acromegaly
Pernicious Vomiting
Severe Hepatic Insufficiency
Starvation
Chlorides (NaCl)
Whole Blood
450-500 mg. %
Plasma, Serum
560-630 mg. %
Urinary Tract Obstruction
Renal Insufficiency with Edema
Hypoproteinemia
Anemia
Nephrosis
Diabetes Mellitus (with Acidosis)
Intestinal Obstruction
Prolonged Emesis: Diarrhea
Extensive Burns
Heat Cramps; Profuse Sweating
Tetany (bicarbonate)
Calcium
Serum 9-11.5 mg. %
Hyperparathyroidism
Hyperproteinemia (as above)
Overdosage with Viosterol
Hypoparathyroidism
Hypoproteinemia
Rickets
Nephrosis
Uremia
Severe Diarrheal States
Osteomalacia
Phosphorus
Inorganic, acid-soluhle
Infants 4-6 mg. %
Adults 3.5-4 mg. %
Nephritis
Pyloric Obstruction
Pituitrin Injection (mild)
Hypoparathyroidism
Bone Fracture Healing
Rickets
Osteomalacia
Pneumonia
After Administration of Insulin,
Adrenalin
Hyperparathyroidism
Nineteen Hundred and Forty-two — January
11
Normal
Increased in
Decreased in
Phosphatase (alk.)
2-4 Bodansky Units
4-10 Greene Units
Bone Metaplasia
Atrophy
Osteomalacia
Osteoporosis
Paget’s Disease
Bone Malignancy
Obstructive Jaundice
Cholesterol (total)
150-230 mg. %
Hypothyroidism
Obstructive Jaundice
Diabetes Mellitus
Xanthomatosis (some types)
Nephrosis
Coeliac Disease
Hepatic Insufficiency
Anemias
Cachexia
Cholesterol Esters
50-80 mg. %
Some Types of Xanthomatosis without
Liver Damage
Severe Liver Cell Damage
COj Combining Power
55-70 vol. %
Alkalosis (above 75)
Excessive Alkali Therapy
Pyloric Obstruction
Emphysema
Acidosis (below 50)
Acid and Acid Salt Therapy
Diabetes Mellitus
Severe Diarrheas without Vomit-
ing
Toxemias of Pregnancy
Pernicious Vomiting
Eclampsia
Uremia
Pulmonary Hyperventilation
DIFFERENTIAL IN JAUNDICE
I Normal Obstructive Hemolytic Intrahepatic
Bile in Stool -1- — -j- +
Bile in Urine — -t- — -|-
Urobilinogen Trace — -j — |- -j- +
Van den Bergh Ind. Direct Ind. Ind.
Quant. Bilirubin 3 mg. - .5 mg. -(-+ H — [- ^ — h
Optimum Levels (Blood)
Molecular Weights
INFECTION*
Hemolytic Streptococcus
Pneumococcus
Meningococcus
Gonococcus
Staphylococcus
Streptococcus Viridans ..
Friedlander’s Bacillus ....
CHEMOTHERAPEUTIC VALUES
Sulfanilamide Sulfapyridine Sulfathiazole Sulfadiazine
8-10
5-10
5-7
8-15
172
249
255
250
++++
4-
++-I-
1 1 -1 - 1
+++
+++
++++
1 i 1 1
1 1 1 1
H — h
1 1 1 -i-
++++
1 r 1
++++
— 1 1 — r
1 1 1 1
1 1 1 1
4- 1 1 1
1 1 1 1
+ +
1 1 1 1
+++
1 r
+++
+
+
+ +
+
H — h
+
+ +
++
+-f+
The tabulated chemical values and their interpretations were originally presented at the clinical-patho-
logical conference of the Maine Medical Meeting held in June, 1940. Because of the number of requests
made by clinicians and laboratory workers for copies, the writers feel that the tabulations have a definite
value for rapid reference. It is presented with the full knowledge that there can be no short-cut to clinical
interpretation of chemical values. The interpretations represent a cross section of opinions obtained by
consulting numerous clinical and laboratory textbooks and interviewing investigators particularly inter-
ested in certain segments of clinical and laboratory investigations. The writers will appreciate the correc-
tion of any errors that may be apparent at this time or become apparent in the future by further investiga-
tions in any of the diseases or clinical syndromes included under clinical interpretations.
* From paper by Dr. Plummer, Westchester County Medical Society, White Plains, N. Y., 1941.
t Published from the Laboratory of Central Maine General Hospital, Lewiston, Maine.
12 The Journal of the Maine Medical Association
Editorials
The Expected Has Happened
Acting ill full accord with her brutal Axis
]3artiier, controlled hy an army cabal pos-
sessed of a congenital belief that the ends
justify any nieaiis the Japanese empire has
committed premeditated murder. The United
States was betrayed and attacked when every
attemjit was being made to find an equitable
and honorable solution of the differences that
existed. There can be but one answer to this
hideous threat and implication ; it cannot he.
What this country will be called upon to
sacrifice in way of lives, blood and treasure
no one can say, no one with sense will try,
but the task must be carried to an end that
wiil mean the utter destruction of men who
believe as do the Axis gangsters and the type
of government they control. Several facts
should give us courage : courage that is not
based on wishful thinking or sloppy senti-
ment. Emphatically we are not a nation help-
less to defend itself against attack from with-
in or without, we are not lacking in men and
women capable of the heart-breaking task
they must assume to save this country from
utter ruin and each and every one of us, no
matter how humble our position may be in
the defense effort, must and will bring to our
jobs that determination and loyalty which
will preserve for our country and others our
ways of life.
Under our form of government, state and
national, we have leaders of our own choice.
Upon the president of this country rests a
responsibility seemingly impossible for one
man to bear but that is exactly what he will
do and since from him we expect and will
obtain a devotion to the task that is his he in
turn should be able to look with confidence to
no less a fidelity on our part.
Uo one knows better than the profession of
medicine the radical treatment required to
destroy malignancy, no matter where situ-
ated. A malignancy of the most hideous type
has attacked the entire world. We have the
men, the science and instruments to ntterly
eradicate it and eradicated it must be. It is
no time for hysteria or confusion and heavy
as the task will be on many it will be made
lighter if they know, as never before, we
stand as a united people with the will and
determination to smash for once and all men
and governments who wonld inflict on us the
death, misery and destruction they have on
others. What will be the task of medicine
remains to be seen. The leaders we have
delegated to certain duties and positions,
men who have accepted assignments of the
utmost importance at the request of their
profession and the government, can be trust-
ed implicitly to warrant the confidence and
faith we have imposed in them.
With Sincere Thanks
With the event of a Uew Year it is an
appropriate and pleasant custom not only to
extend greetings for the year to come bnt
thanks to those who have made possible many
things we are gratefnl for in the year now
past. At no time, since the present editorial
hoard has conducted the Journal, has there
been on file as many instrnctive and interest-
ing papers for publication as we have at
present. Without conceit it may be assumed
that authors are finding the Journal a
worth while medium and while it is not for
ns to say that the editorial content has im-
proved it has at times called for favorable
comment. ISTow and then a member dictates
a letter to his stenographer indicating that
he is pleased with something on the editorial
pages and more power to ns. Some even
write a personal note — which is gratifying —
since editorial boards and editors are no less
susceptible to a little praise than others.
13
Nineteen Hundred and Forty-two — January
All details of publication are, as should
be, under direct control of the Council of the
association. Last year, ending’ June, 1941,
due to the efficient management of Dr. Carter
and Mrs. Kennard the Jouknal showed a
small balance in the black which it is hoped
can be duplicated this year. Total advertis-
ing contracts are gratifyingly stable but, like
many others, j^riorities for defense will affect
us in supplies obtainable and cost. The num-
ber of original papers abstracted by other
publications and requests to re-print articles
in whole or part are more numerous. Since
the JouEjsTAL is also the official organ of the
Maine Hospital Association the Council ap-
pointed from that closely affiliated body, Dr.
Joelle C. Hiebert of the Central Maine Gen-
eral Hospital and Dr. Allan Craig of the
Eastern Maine, to the editorial board; wel-
come they are.
With few exceptions no State Journal can
hojDe, or should it try, to compete with publi-
cations of a much wider scope and sphere but
every State journal occupies, or should, a
more intimate relationship with its own
members than those of special or national
fields and serves a purpose impossible to
them. As we read the various State journals,
with their many papers and editorials of
worth while interest, it is the sincere wish
and hope of the editorial board — as the
JouEXAL, goes on — that it will continue to
merit your hearty support and cooperation so
that an approach can be made to the enviable
position held l)y many of our welcome ex-
changes. At any time and from any one the
board welcomes friendly criticism. If you
see, or think you see, wherein the Jouexal,
can be bettered your suggestions will be
gratefully received.
Many events in the last two years have
tried nation after nation to the breaking
point. Some have gone dovm, undemiined
by treachery or before the onslaught of a
hideous mechanized violence the like of
which the world has never seen, seemingly
beyond reparation. Some have refused to
bow their heads to the brutal nation respon-
sible for the cataclysmic misery and horror
now the fate of many millions. Is all this
^Gn uncomfortable dream, from which we
shall awaken to plod along again in our com-
fortable middle-class fashion” asked the Neiv
England Journal of Medicine well over a
year ago ? Let us give thanks if we have
eves that can see, if we have ears that can
hear, before it is too late. It is too late for
some.
Pay Your 1942 State and County Dues Promptly
to Your County Secretary
Medical Queries Answered — Continued from page 8
tion in the medium-sized bronchi. This does
not, however, rule out the possibility that ner-
vous mechanisms may play a part.
QUESTION : What is the 'pathology and
etiology in lupus erythematos'os disseminala?
ANSWER:
De. Kaesxee : It has now become the
fashion to say that when the cause of a dis-
ease is not absolutely known that it is upon
an allergic basis. This cannot be proven as
concerns lupus erythematosus disseminata.
In the skin there is deterioration of the walls
of blood vessels together with a massive sur-
rounding infiltrate of mononuclear cells,
principally l^mlphocytes. The same is true
in the internal viscera and the effects are
often found in the kidney together with a dis-
ease of the glomerular tufts. There is likely
to be that form of endocarditis which Libman
characterized as indeterminate. An excellent
description of the pathology is by Klemperer,
Pollock and Baehr, Archives of Pathology,
October, 1941.
14 The Journal of the Maine Medical Association
A Call to the Medical Profession^
The nation is at war. The Congress has
passed an amendment to the Selective Service
Act which will call for registration of every
man up to the age of 65 and which will place
all men under 45 years of age subject to serv-
ice at the order of the Selective Service
boards.
The Procurement and Assignment Service
for Physicians, Dentists and Veterinarians
was established by order of the President on
October 30. Thus the medical profession it-
self aids in determining proper distribution
of the medical profession in supplying the
needs of the armed forces and maintaining
medical service to civilian communities, pub-
lic health agencies, industrial plants and
other important needs.
At a meeting of the Procurement and
Assignment Service held in Chicago at the
headquarters of the American Medical Asso-
ciation of December 18, jointly with the
Committees on Medical Preparedness of the
American Medical Association, the American
Dental Association and the American Veteri-
nary Medical Association, plans were drawn
for making immediately available to the
United States Army and 14avy Medical
Corps the names of physicians who wish to
be enrolled promptly in the service of the
government in this emergency.
On the opposite page is published a blank
by which every physician may at once place
his name with the Procurement and Assign-
ment Service as one who is ready to serve the
nation as the need arises. If you wish to
make yourself available for classification, fill
out this blank and send it at once to Dr. Sam
F. Seeley, Executive Director of the Procure-
ment and Assignment Service. When these
blanks are received, they will be classified and
checked with the information available in the
national roster of physicians at the headquar-
ters of the American Medical Association.
For two thousand and nine counties in the
United States, lists have been prepared indi-
cating physicians who are engaged in neces-
sary civilian projects, public health services
or educational activities from which they can-
not be spared. Shortly the rest of the coun-
ties will have such lists available.
In each of the corps areas covering the
United States a committee is being estab-
lished, including representatives of medical,
hospital, educational, dental and veterinary
activities. In the individual states, commit-
tees of medical, dental and veterinarian pro-
fessions are being established through which
the corps area committees will exercise their
functions. In each county also local commit-
tees will provide accurate information re-
garding the status of each member of the
profession concerned.
The raising of the Selective Service age
from 28 to 45 will place a great number of
additional physicians in the category of those
on whom the nation may call as their services
are needed. Estimates indicate that some
sixty thousand physicians thus become avail-
able for service and that forty-two thousand
dentists under the age of 45 also become sub-
ject to call. By enrolling with the Procure-
ment and Assignment Service immediately,
utilizing the blank on the opposite page, all
physicians, but particularly those under 45
years of age, insure to every extent possible
assignment to the type of service for which
they are best fitted. They avoid thus also the
possibility of unclassified service with the
United States Army during the period that
may be necessary following selection by the
Selective Service before the commission can
be secured. A physician called by the Selec-
tive Service who has not enrolled or who is
not on a reserve list obviously serves without a
commission during the time that necessarily
elapses before a commission is secured. In
future issues of The J ourhal announce-
ments will be made regularly of the numbers
of those who enroll and of the extent to which
the immediate needs of the Army, Uavy and
other government agencies are being supplied.
* As published in The Journal of the American Medical Association, December 27, 1941.
Nineteen Hundred and Forty-two — January
15
Enrolment Form for Procurement and Assignment Service for
Physicians
Dr. Sam F. Seeley, Executive Officer
Procurement and Assignment Service
New Social Security Building
4th and C Streets S.W.
Washington, D, C.
Bear Doctor Seeley :
Please enroll my name as a physician ready to give service in the Army or Navy of the
United States when needed in the current emergency. I will apply to the Corps Area com-
mander in my area when notified by your office of the desirability of such application.
Signed
1. Give your name in full, including your full middle name :
2. The date of your birth :
3. The place of your birth :
4. Are you married or single ?
5. Have you any children ? If so, how many ?
6. Do you believe yourself to be physically fit and able to meet the physical standards
for the Army and Navy Medical Corps?
7. Have you filled out previously the questionnaire sent to all physicians by the
American Medical Association ?
8. When and where were you gnaduated in medicine ?
9. In what state are you licensed to practice ?
10. Do you now hold any position which might be considered essential to the main-
tenance of the civilian medical needs of your community ? If so, state these appointments :
11. Have you previously applied for entry into the Army or Navy Medical Service?
If so, state when, where and with what result (if rejected, state why).
Signature
Date
Address
f
o
Nineteen Hundred and Forty-two — January
17
Necrology
Charles Bradford Sylvester, M, D,, 1865-1941
‘Born in Casco, Maine, February 12, 1865.
Bridgton Academy, 1884.
Maine Medical School (Bowdoin), 1889.
Special Course in Pathology (Harvard), 1909 &
1910.
House physician and interne at N. Y. Infant’s
Hospital and Randall’s Island Hospital, 1889
& 1890.
General private practice, Harrison, Maine, 1890 to
1918.
Married: Flora D. Bray, January, 1891. Children:
Ruth B., Laurance B. (deceased).
Married: Mary F. Whitney, August, 1896. Chil-
dren: Miriam C., now Mrs. Merrick Atherton
Monroe; Allan W., M. D. (deceased). Allan’s
son, Stanley B., also survives.
United States Army, 1918 & 1919. Commissioned
first lieutenant in Medical Reserve Corps,
followed by active duty in the Tuberculosis
Service, in Camps Oglethorpe and Sevier, and
General Hospitals No. 17 and No. 16. Retired
by age in 1929 as lieutenant-colonel.
Internist, Portland, Maine, 1919-1941.
Asthma clinician in out-patient department of
Maine General Hospital, 1925-29.
Asthma consultant, Maine General Hospital, 1927-
1937.
Allergy clinician, Maine Public Health Associa-
tion, 1925-1930.
President, Oxford County Medical Association,
1908.
President, Cumberland County Medical Associa-
tion, 1918.
President, Maine Medical Association, 1930.
Received medal from Maine Medical Association
in 1939 for fifty years of active medical prac-
tice.
Fellow of American College of Physicians, 1931- .
President of Maine Public Health Association,
1940- .
Director for Maine, National Tuberculosis Asso-
ciation, 1936-1940.
Fellow of American Academy of Tuberculosis
Physicians, 1937- .
President of Board of Trustees of Bridgton Acad-
emy.
State Street Congregational Church Men’s Club,
Portland Medical Club.
Published articles:
Prevention of Tuberculosis, Maine Medical
Journal, 1909.
Report on Asthma in Maine, Maine Medical
Journal, 1929.
Ragweed-Pollen Survey in Maine for 1937, in
Neiv England Joxirnal of Medicine, 1938, in
conjunction with 0. C. Durham, Chicago.”
Although, in recent years. Doctor Sylvester’s
talent was applied largely in the fields of tuber-
culosis and allergy, nevertheless he was a splen-
did example of that rare type of all-around physi-
cian to whom patients in mental or physical dis-
tress could and did appeal with assurance that
their complaints would receive sympathetic con-
sideration.
He was a man of healthy sensibility of mind,
possessed of an elevated understanding and of
great goodness of heart, who was much beloved
and respected by all who came within the wide
sphere of his influence. Far from ever having
recourse to questionable or illegitimate means of
advancing himself in the world. Doctor Sylvester
adopted the following sentiment from Pope:
“But if the purchase cost so dear a price.
As soothing folly or exalting vice.
Then teach me. Heaven ! to scorn the guilty bays.
Drive from my breast that wretched lust of praise;
Unblemished let me live, or die unknown.
Oh, grant an honest fame, or grant me none.”
Thus did he live to the end which came on the
18th of December, 1941.
E. W. Gehring.
18
The Journal of the Maine Medical Association
County News and Notes
Cumberland
The 161st meeting of the Cumberland County
Medical Society was held at the Eastland Hotel,
Portland, Me., December 5, 1941. The President,
Doctor George O. Cummings, called the meeting to
order at 8.00 P. M. Following preliminary re-
marks the speaker of the evening, Doctor R. P.
Parsons of the Medical Corps, U. S. N., was intro-
duced. Doctor Parsons’ subject was Some Prob-
lems in Naval Medicine. He described the prob-
lems of military medicine as compared with those
of civilian life. His paper was discussed by Drs.
Simpson, Minor, and Decheco of the Portsmouth
Naval Unit, by Commander Adamkiewicz of the
Portland Inshore Patrol, and also by Drs. E. H.
Drake and Thomas A. Foster. Doctor Parsons also
spoke briefly on the subject of Yaws and Medicine
in Haiti.
The paper of the evening was followed by the
annual business meeting. Annual reports of the
Secretary and Treasurer were read and approved.
It was the recommendation of the Council that
Navy wives and famiiies of local naval personnel
be attended by local physicians as private patients,
and that the local physicians extend to them what-
ever courtesy in the way of minimum professional
rates they feel is indicated, dependent upon the
circumstances of each case. The attention of the
members was called to the action of the council in
December, 1941, regarding dues of members absent
because of duty with the National Defense Pro-
gram. Also the action taken by the House of Dele-
gates of the Maine Medical Association in session
at York Harbor, Sunday, June 22, 1941, as follows:
“Members who have entered the service are exempt
from the payment of dues while in the service.”
The nominating committee, consisting of Drs.
W. F. W. Hay, T. A. Foster, and DeForest Weeks,
appointed to nominate officers for the ensuing
year, reported as follows:
President, Roland B. Moore, M. D., Portland.
Vice-President, N. B. T. Barker, M. D., Yarmouth.
Delegates to the Maine Medical Association:
Two years — Drs. Thomas A. Foster, Frank A.
Smith, DeForest Weeks; Alternates: Drs. Euward
A. Greco, and Louis L. Hills. Delegates one year —
Drs. Elton R. Blaisdell, Philip H. McCrum, Clyde
E. Richardson, and Richard S. Hawkes. Alter-
nates: Drs. Alvin E. Ottum, and Francis W. Han-
lon.
Committee on Public Relations: Drs. Harold V.
Bickmore, Theodore C. Bramhall, and Roderick L.
Huntress.
Legislative Committee: Drs. Edwin W. Gehring,
and Franklin A. Ferguson.
Council: George O. Cummings, M. D.
It was voted that the report of the Nominating
Committee be accepted.
Dr. Ralf Martin’s application for membership
was presented and referred to the Council. Dr.
William Monkhouse, of Lovell, was accepted to
membership by transfer from the Oxford County
Medical Society.
The meeting was adjourned at 10.00 P. M.
An afternoon clinical program, held at the
Maine General Hospital, .preceded the evening
meeting.
Respectfully submitted,
Eugene E. 0’Donnex.l, M. D.,
Secretary.
Franklin
The annual meeting of the Franklin County
Medical Society was held at the Franklin County
Memorial Hospital, Farmington, Maine, on Decem-
ber 1, 1941.
The Secretary-Treasurer’s report was read and
accepted.
The President, Frank L. Springer, M. D., ap-
pointed the following Nominating Committee:
Drs. B. L. Arms, James W. Reed, and Lorrimer M.
Schmidt.
The following officers were elected for the ensu-
ing year:
President: James W. Reed, M. D., Farmington.
Vice-President: Harry Brinkman, M. D., Wil-
ton.
Secretary-Treasurer: Lorrimer M. Schmidt,
M. D., Strong.
Delegate to the Maine Medical Association:
George L. Pratt, M. D., Farmington.
Alternate: James W. Reed, M. D.
Board of Censors: Maynard B. Colley, M. D.
(1942); Currier C. Weymouth, M. D. (1943);
Frank L. Springer, M. D. (1944).
It was voted that the County Society cooperate
with the fee schedule as set up by the State De-
partment of Health and Welfare for welfare cases
until such a time that changes are made in this
schedule by the Council.
Lorrimer M. Schmidt, M. D.,
Secretary.
Kennebec
The annual meeting of the Kennebec County
Medical Association was held at the Augusta State
Hospital, Thursday, December 18, 1941.
Clinical session at 5 P. M. which was a presenta-
tion of cases by members of the Staff.
Dinner at 6.30 P. M. was followed by a business
meeting.
Minutes of the last meeting were read and ap-
proved.
The reports of the Secretary and Treasurer for
1941 were read and accepted.
A. B. Allen, M. D., of Richmond, Me., was ad-
mitted to membership by transfer from the Penob-
scot County Medical Association.
Jos. H. Michaud, M. D., of Waterville, was rein-
stated to membership, and also Rodney D. Turner,
M. D., of Augusta.
It was voted that the fee schedule for State
cases as submitted by Mr. Joel Earnest and ap-
proved by the Council of the Maine Medical Asso-
ciation be accepted.
A telegram from George Baehr, M. D., Chief
Medical Officer, Civilian Defense, Washington,
D. C., relative to the establishing of emergency
medical field units was read by the Secretary.
The following members were appointed by the
Chair to nominate the officers for the ensuing
year: C. R. McLaughlin, M. D., Gardiner; George
A. Coombs, M. D., Augusta; T. C. McCoy, M. D.,
Waterville.
They reported as follows:
President: L. Armand Guite, M. D., Waterville.
Vice-President: A. J. Gingras, M. D., Augusta.
Secretary-Treasurer: Frederick R. Carter, M. D.,
Augusta.
Nineteen Hundred and Forty-two — January
Councilor for three years: Arnold W. Moore,
M. D., Mt. Vernon.
Two Delegates to the Maine Medical Associ-
ation : Ivan E. McLaughlin, M. D., Gardiner;
Frank Bull, M. D., Gardiner.
Alternate: M. T. Shelton, M. D., Augusta.
It was moved and seconded that the by-laws be
suspended and the Secretary cast one vote for the
officers for the ensuing year which was done.
The address of the evening was given by Douglas
A. Thom, M. D., Professor of Psychiatry, Tufts
Medical School; Consultant in the Massachusetts
Division Mental Hygiene; Formerly Director of
the Massachusetts Department of Child Guidance
Clinics, who spoke on War Neuroses and Psy-
choses, which was based on his experiences in the
World War No. 1. He also spoke on medical hy-
giene of children. This talk was very interesting
and instructive.
There were forty members and guests present.
Respectfully submitted,
Frederick R. Carter, M. D.,
Secretary.
Knox
The regular monthly meeting of the Knox
County Medical Society was held at the Copper
Kettle, Rockland, Maine, on November 18, 1941.
The dinner and meeting followed the Staff Clinic
which Francis Thurmon, M. D., of Boston, con-
ducted. Many interesting patients were shown,
and some difficulties in the way of diagnosis
explained.
Doctor Thurmon was guest speaker for the
evening and spoke on Extra-genital Sores. With
the slides which he showed a clear concept of
these lesions was given.
P. L. B. Ebbett, M. D., of Houlton, President of
the Maine Medical Association, was present and
explained the suggested fee schedule for State
welfare cases.
The general discussion which followed was very
instructive.
A. J. Fuller, M. D.,
Secretary.
Penobscot
The Penobscot County Medical Association held
its monthly meeting on Tuesday, December 16,
1941, at the Bangor House, Bangor, Maine.
Leonard G. Miragliuolo, M. D., of 253 Hammond
Street, Bangor, was elected to membership.
H. L. Robinson, M. D., of Bangor was appointed
to represent the Penobscot County Medical Asso-
ciation in the medical civil defense organization
of the State.
Mr. Joel Earnest, Commissioner of Health and
Welfare, was present and spoke to the members
relative to the proposed fee schedule for State
welfare cases.
The paper of the evening was by Myer Saklad,
M. D., and his subject was Choice of Anesthesia in
General Practice.
There were fifty-three present.
Respectfully submitted,
Forrest B. Ames, M. D.,
Secretary.
Piscataquis
A meeting of the Piscataquis County Medical
Association was held at Dr. Harvey C. Bundy’s
residence in Milo, Maine, on November 26, 1941.
19
Roscoe L. Mitchell, M. D., Director of the State
Department of Health and Welfare, gave a very
interesting and instructive talk regarding the his-
tory of the State Department of Health. He also
told us of the many ways one can be helped
through the Department.
N. H. Nickerson, M. D.,
Secrretary.
New Members
Androscoggin
Robert A. Frost, M. D., Auburn, Maine.
A. W. Mandelstam, M. D., Lewiston, Maine.
Cumberland
William Monkhotise, M. D., Lovell, Maine. (By
tranfer from the Oxford County Medical Society.)
Kennebec
Adalbert B. Allen, M. D., Richmond, Maine. (By
transfer from the Penobscot County Medical Asso-
ciation.)
Joseph H. Michaud, M. D.. Waterville, Maine.
Rodney D. Turner, M. D., Augusta, Maine.
Penobscot
Leonard G. Miragliuolo, M. D., Bangor, Maine.
Coming Meetings
Penobscot
Penobscot County Medical Association, Forrest B.
Ames, M. D., Bangor, Secretary.
January 20, 1942, Bangor, Maine.
Speaker; Champ Lyons, M. D., Massachu-
setts General Hospital, Boston, Massa-
chusetts.
100% Paid-Up Membership
for 1942
Piscataquis County Medical Society
Notices
State of Maine
Board of Registration of Medicine
Adam P. Leighton, M. D., Portland, Secretary.
List of successful applicants passing the Maine
Medical Board November 12-13, 1941.
Through Written Examinations
Winford C. Adams, M. D., Eastern Maine Gen-
eral Hospital, Bangor, Me.
Leslie William Brownrigg, M. D., St. Stephen,
N. B.
William Neil Campbell, Jr., M. D., Boston Lying-
in Hospital, 221 Longwood Ave., Boston, Mass.
William Steven Dick, M. D., 1104 31st St., Par-
kersburg, West Virginia.
Jere Robert Downing, M. D., Kennebunk, Me.
Edward Carlton Dyer, M. D., The Children’s Hos-
pital, Boston, Mass.
20
The Journal of the Maine Medical Association
Francis Hugh Fox, Jr., M. D., Kings County-
Hospital, Brooklyn, N. Y.
Bela Kaszas, M. D., Menorah Hospital, Kansas
City, Mo.
Wilbur Berry Manter, M. D., Rhode Island Hos-
pital, Providence, R. I.
Howard Harold Mintz, M. D., Long Island Hos-
pital, Boston, Mass.
Thomas Michael Mulcahy, M. D., 101 East 74th
St., New York City.
Through Reciprocity
Glidden Lantry Brooks, M. D., 300 Main St.,
Lewiston, Me.
Vincent Gould, M. D., 1300 Maple View Place,
S. E., Washington, D. C.
Cilly Hirschberger, M. D., 619 West 144th St.,
Apt. H, New York City.
John S. Houlihan, M. D., 46 Pern St., Bangor,
Me.
Albert C. Johnson, M. D., 635 Lawn Ave., Bridge-
port, Conn.
President’s Address
to become a real burden and a detriment, but
this can be avoided. Each of our hospitals
can easily set up an informative and simple
system which will be of inestimable value,
not only to the Trustees and Superintend-
ents, but in the institution’s efforts to obtain
public or private funds.
We could not liring- another year to a close
without expressing our sincere appreciation
for the splendid work being carried on in
this State by the Bingham Associates. The
opportunities made possible for a large num-
ber of the smaller hospitals and their medical
staffs toward the greater development of
scientific work are of inestimable value both
to the patients and the physicians in these
institutions.
During the past year, some of our hospitals
have encountered legal problems which have
been somewhat confusing and disconcerting.
In order that eacli of our institutions may be
assured of proper legal protection, I would
suggest that each hospital look carefully to
its articles of incorporation in order to be
sure that there are no loopholes which might
sul)ject the hospital and its management to
embarassing legal difficulties.
With the dark clouds of uncertainty hov-
ering above us and the fact that we know
Hitler and his bloodthirsty Axis pirates are
prepared to pounce upon us when it suits
their convenience, every citizen and every
institution must be ready to meet whatever
emergency we might be called upon to face.
Each hospital in each community is morally
obligated to be fully prepared.
Daniel Dudley Lovelace, Jr., M. D., Gorham, Me.
Eugene Patrick McManamy, M. D., Mayo Clinic,
Rochester, Minn.
Marion King Moulton, M. D., West Newfield, Me.
Horace P. Russell, M. D., 81 Fairview Ave.,
Chicopee, Mass.
Benjamin Lawrence Shapero, M. D., 114 Essex
St., Bangor, Me.
Edward Emanuel Sheldon, M. D., 250 West 71st
. St., New York City.
William A. Ventimiglia, M. D., 16 Lincoln St.,
Augusta, Me.
Horatio John Young, M. D., Machias, Me.
American College of Physicians
The annual New England Sectional Meeting of
the American College of Physicians will be held
at Providence, R. I., on Wednesday, January 14,
1942.
Continued from page 9
The Governor has set up a Civil Defense
Organization in our State, with Col. Sher-
man Shumway of Bangor as its head. With
your approval, I hereby offer to Governor
Sewall and Col. Shumway the full coopera-
tion of the Maine Hospital Association in the
preparation and work for Civil Defense in
Maine. There must be no quibbling or hold-
ing back in times like these, for together we
stand, divided we fall, and there is no place
for timid souls !
How many emergency cases could you take
care of in your hospital now if suddenly
called upon ? How is your stock of bandages,
dressings, and instruments ? Have you an
extra supply of cots and stretchers which could
be placed in corridors and waiting-rooms ?
What ambulance service have you available ?
These are but a few of the many questions
which all our hospitals should answer for
themselves now.
I hope that the acid test of emergency will
not be put to your hospital or mine, but, after
all, hopes are often but wishful thinking, and
as we in Maine are, by geographical location,
the farthest east of all states, we have a two-
fold reason to be well prepared at all times.
Of the coming year, who can possibly pre-
dict ? Unquestionably, we face most difficult
economic and personnel problem. Rigid econ-
omies and substitutions will be required of
all of us, but I am sure that the hospitals of
this state will not be found wanting in their
loyalty and devotion to their great humani-
tarian purpose.
The Journal
of the
Maine Medical Association
Uolume Thirti^^three Portland, Ulaine, Februan^, 1942
No. 2
A Critical Survey of the Treatment of Burns
By R. H. AldeicHj M. D., Boston, Massachusetts
During the last fifteen years the treatment
of bums has been in an amorphous condition.
Different schools of thought divide the coun-
try, each school apparently considering its
findings to be the ultimate in scientific truth.
There has constantly been a great deal of in-
ternal dissention with no real cooperation be-
tween various gi’oups.
This unsettled condition has not been with-
out certain values however. The processes of
critical, and sometimes antagonistic analysis
have at least obtained a few positive virtues.
Some of the older forms of treatment that
were obviously of no real use have been
dropped, leaving the field clear for a few of
the more modern forms of treatment.
As one looks back over the history of the
treatment of burns it is obvious that what has
been going on in the last fifteen years is sim-
ply a condensation and a magnification of
what has been happening since the beginning.
The general therapeutic trend, in most other
diseases has shown a fairly consistent rise,
although the curve was sometimes fiuctuant.
It is peculiar that the curve representing the
treatment of burns can only be plotted by a
series of distorted circles^ Types of treatment
have always been cyclic, recurring at varying
intervals. For example, tannic acid for treat-
ing burns was advocated 600 years B. C. by
the Chinese, again 400 years later by Hip-
pocrates ; for a third time by Paulus of
Aegina somewhere around the third century,
A. D. In 1895, tannic acid was championed
by an anonymous writer in the Pittsburgh
Medical Gazette, and in 1925 became a
standard form of treatment sponsored by the
monumental work of Davidson. Carron oil
was introduced twice, once in the third cen-
tury B. C. by Cerapion and again in 1809
by Samuel Cooper. The water bath was also
discovered twice. Aetius used it in the sixth
century A. D. and Passavant rediscovered it
in 1858. In recent years, even such a treat-
ment as melted paraffin has gone through two
cycles. Lawson Tait began the treatment in
1864 and gave it a very brief popularity. In
1915 due to the stimulus of the first World
War, it was rediscovered and presented as
Am hr in again enjoying short-lived popu-
larity.
An analysis of the reasons for the recur-
rent use and rejection of the various treat-
ments for burns reveals one important fac-
tor. The treatment has been in the main em-
pirical, based upon insufficient laboratory
data and aimed at treating a condition about
which very little was known. Lack of con-
tinuity of treatment is due to the lack of con-
tinuity in the conception of the pathology of
burns. In no other field where the conditions
are relatively as simple has there been so
22
The Journal of the Maine Medical Association
iiiiicli theorizing. Indeed in this field theory,
lacking the restraint of adequate clinical and
laboratory observation, has soared into the
realm of philosophy.
The recent history of the treatment of
burns is very disturbing. It seems inconceiv-
able that modern scientific medicine should
continue to employ an unscientific approach
to this problem. Certain theories as to the
etiology of the toxemia of burns have defi-
nitely been proven to be wrong and yet many
forms of treatment are brought out based on
these fallacies and they continue to be accept-
able to the vast majority of modern doctors.
Other theories that are apparently based on
sound laboratory work are disregarded. The
most astounding accusation that can be made
is that doctors as a whole are still looking for
an easy way to take care of burns and are
deliberately avoiding all forms of treatment
no matter how logical they seem if they in-
volve too much time and effort.
Since 1925, in this country the types of
treatment used on bums have been multiple.
A partial list of treatments include tannic
acid, tannic acid and silver nitrate, gentian
violet, gentian violet and silver nitrate, dry
heat, liquid air, complete debridement, ex-
sangTiination and transfusion, adrenalin, pic-
ric acid, picrate salves, cod liver oil, cod liver
ointments, the halogens in oil, various pastes
and ointments, triple dyes, blood and serum
transfusions, the water bath, and the sulfona-
mides.
It is no exaggeration to state that if one
looks through the medical literature for the
last fifteen years, one will find over three
thousand articles on the subject, most of them
written with a great deal of vehemence. The
advocates of each form of treatment have con-
clusively proved to themselves that theirs is
the only method of treating a burn and that
everybody else is wrong. However, most of
the proofs are seventy-five per cent faith and
it is rare indeed to find an article scientific-
ally written based on large series of cases.
There must be some exit from the pyro-
logic labyrinth. This exit is not going to be
found by philosophizing as to the causes of
the toxemia and the best forms of treatment.
The problem requires a great deal of work,
and the work should be started soon, as the
problem is bigger than most physicians
realize.
According to the 1939 statistics published
by the Hational Safety Council, burns ac-
counted for twenty three per cent of all acci-
dental deaths occurring under the age of five.
From five to fifteen, burns killed thirteen per
eent of our population who died by accidental
means and from fifteen years on burns took a
toll of six per cent of all of our accidental
deaths. To present the picture in a slightly
more modern form, in 1940 there were ten
thousand people killed in England by bombs.
In this country over ten thousand are killed
by burns every year and yet it stirs no tre-
mendous feeling of responsibility among doc-
tors. It is very significant that throughout
the country as a whole the average clinic runs
a burn mortality between thirty and forty
per cent, and yet it has been conclusively
shown by a few men interested in the subject
that the mortality need be no more than ten
per cent if the proper work is done. These
last statements are not made in a sense of
accusation, but only in the hopes of awaken-
ing the medical profession to the tremendous
problem presented by the burned patient.
In order to devise a rational type of treat- -
nient the underlying cause of toxemia must
be understood. It will bear repetition to re-
view a few of the major theories advanced as
to the etiology of the toxemia and death fol-
lowing burns.
The first so-called modern theory dealt
witli the loss of the functions of the skin as
the causative agent. This theory assumed
that the destruction of the skin functions of
secretion, heat regulation and sensation
brought about the toxemia. Many ingenious
experiments were done to prove or disprove
this theory and it is now generally regarded
as ol)solete, interesting only from an histori-
cal viewpoint.
The theory of toxic absorption was next
brought out and advanced by a large group of
investigators. It is based on the assumption
that there is formed in the site of the burn,
produced by an alteration of proteins, a toxic
sul)stance which is absorbed by the body and
that this is responsible for the general reac-
tion of the patient. A wide variety of sub-
stances have been described by a great many
investigators. Some of the substances men-
Nineteen Hundred and Forty-two — February
tioiied are liistamiue, histidine, pyridin,
guanidin, the ptomaines and the primary and
secondary proteoses. There has been little or
no correlation of various gTonps of workers
engaged in this problem. In fact the more
this theory is advocated, the more confused
it becomes and even the experiments in 1923
by Robertson and Boyd have been disproved
by Underhill and Ivapsinow. Robertson and
Boyd published a paper in which they
claimed to have found in the skin of burned
animals a toxin which ‘‘circulates in the
blood either in or adsorbed by the red cor-
puscles and which causes the symptoms seen
in bad superficial burns and in some cases
death.” . . . “the toxic substance consists of
two portions, one of which is thermostabile,
diffusible and neurotoxic ; the other is thermo-
labile, colloidal and necrotoxic. Chemically
the toxic consists of primary and secondary
proteoses.” They described the chemistry and
the physics of this split protein and seemed
to have settled the problem and definitely
established the theory of toxic adsorption as
being the real etiology of the burn syndrome.
Underhill and Kapsinow repeated the ex-
periments of Robertson and Boyd, duplicat-
ing them in every detail. They confirmed the
results above described, in that an extract of
burned skin prepared according to the technic
of Robertson and Boyd was toxic wTen in-
jected into gminea-pigs ; however, they also
obtained the same results by preparing and
injecting nonnal skin in the same manner.
Unable to believe in a skin toxin they ana-
lyzed the extract which was alcoholic, and
found a sufficient quantity of alcohol to ac-
count for the symptoms exhibited by the
burned animals. As a control this amount of
alcohol was injected alone into giiinea-pigs
with exactly the same toxic results. This
leads one to believe that the primary and
secondary proteoses described by Robertson
and Boyd was simple ethyl alcohol. Under-
hill injected whole blood from a burned pa-
tient into animals and found no toxicity
resulted.
Underhill, Ivapsinow and Fisk injected
trypan and methylene blue into the burned
area of experimental animals and on no test
could they find either of these substances in
the urine or blood stream afterwards. In
another series they injected five times the
lethal dose of strychnine into burned areas
of exjDerimental animals without any signs of
strychnine poisoning being apparent in any
of the animals. If these three substances can-
not be detected in the blood stream on any
occasion, it seems inconceivable that a vague
split protein can be absorbed in one hundred
per cent of the large burns in sufficient quan-
tities to cause the inevitable signs of toxemia
and in many cases death.
The third theory was advocated by Under-
hill. This theory might be called the theory
of hemo-concentration. Underhill showed ex-
perimentally that a third degree burn of one-
sixth of the body area in an animal causes a
loss of seventy-five per cent of the circulating
blood plasma in twenty-four hours. This, of
course, results in a terrific concentration of
the solid elements of the blood. Some of
Underhill’s animals showed a hemaglobin of
two hundred and forty. It is well known that
a hemoglobin of one hundred and forty is not
compatible with life for any length of time.
On the basis of this theory Underhill advo-
cated the curbing of blood changes as the best
treatment. He stated that if the blood were
kept within the normal limits for all of its
constituents, there would be no toxemia and
no death.
Underhill’s treatment is an excellent one as
a first-aid measure and for combatting shock,
but it is obvious to all surgeons who have
handled many burned patients that his form
of treatment does not prevent the toxic con-
dition exhibited from the fourth day onward.
Underhill’s mortality figures also do not bear
out his theory.
In 1928, Firor and Aldrich brought out
the theory of infection. Their work was
based on a bacteriological study made on all
the burns entering the John Hopkins Hos-
pital over a period of months. They showed
that for the first eighteen hoTirs the burned
areas were practically sterile. From the
eighteenth hour to the fortieth hour the cul-
ture reports came back positive for a mixed
infection which gTew heavier as the time ad-
vanced. Between the fortieth and seventy-
second hour some one form of the strepto-
coccus outgrew all other organisms and at the
end of the seventy-second hour the culture re-
ports on one hundred per cent of the large
burns revealed a pure culture of a virulent
24
streptococcus. Their work was later corrobo-
rated by Cruiksliank in the Royal Infirmary.
He had the same findings on two hundred
consecutive burns. This for the time being,
at least, established the cause of toxemia and
death as being a streptococcic invasion of the
body.
In 1929, Firor and Aldrich advocated the
Gentian violet treatment as the logical one
to combat the infection. Their treatment was
used in conjunction with proper treatment
for shock and a careful estimate of the blood
throughout the patient’s convalescence.
In 1934, Aldrich brought out a mixture of
three of the aniline dyes as a better form of
treatment then gentian violet alone as gentian
violet was not a specific antiseptic against the
gram negative organisms. He found by com-
bining crystal violet, brilliant green and neu-
tral acriflavine, a synergistic reaction was ob-
tained, giving the mixture a high specificity
against all organisms. This mixture is non-
toxic and forms a light flexible eschar by com-
bining with the upper portion of the burn.
This prevents pain and fluid loss and acts as
a scaffolding for the new growth for epi-
thelium.
Before evaluating the various forms of
treatment, it is considered highly essential
to discuss the freshly burned patient. A
newly burned patient should be considered
primarily not a burn at all, bnt a case of
shock. If the mortality of burns is to be re-
duced to the lowest possible level, it is very
necessary that the patient be allowed to live
long enough to combat his burns. If he is not
given this fighting chance and is allowed to
die of shock, the mortality minimum will
never be reached. As the majority of burned
patients are in good health before the acci-
dent, it is not too drastic to state that if a
patient with a third degree burn of seventy-
five per cent of the body area or less dies
within the first seventy-two hours, that death
can be laid at the feet of the surgeon taking
care of him. It is purely a shock death un-
less there are other complications, and with
our present knowledge of combatting shock,
it need not occur.
There is absolutely no first aid treatment
for large bums. Too many first aid students
are being developed by various organizations
for the good of the burned population. To
The Journal of the Maine Medical Association
attempt removal of burned clothing and
elaborate handling and bandaging is to invite
early mortality. In burns of twenty per cent
of the body area or more the aim should be
to take care of the patient as one who is in
shock or will shortly go into shock and to
leave the treatment of burns in the hands of
the surgeon who will take care of it after the
patient is hospitalized.
Heat, rest, fluids and the control of pain
are the four fundamental considerations to
be given to a large fresh burn. When these
have been provided for the proper type of
treatment for the burn can be instigated and
the patient will then have a chance to recover
from his burned areas or to die because of
them rather than from shock.
It is generally conceded that tannic acid
and the aniline dyes are the two modern
forms of early treatment for burns. Cer-
tainly these two forms of treatment are used
more than any of the others. Certain of the
salves have been put on the the market and a
great deal of pressure has been used to in-
crease their use. In most instances the use
of any one salve is short-lived and a careful
study reveals that such forms of treatment
are not widely taken up by the medical pro-
fession for treating large burns.
The tannic acid treatment for burns was
brought out by Dr. Davidson of Detroit in
1925. It is now being used widely through-
out the medical world and it is a very good
treatment for the first few weeks in the case
of a burn patient.
Those clinics that are interested in the care
of bnrned patients and use the tannic acid
according to the technique advocated by the
Detroit group rej)ort fairly low mortalities.
Its beneficial features are derived from its
escharotic action and the aseptic manner in
which it is applied. The technique for its use
as advocated by the Detroit school is a rigid
one.
When the bnrned patient is brought into
the hospital he is anesthetized as soon as it is
feasible. The burned areas are then thor-
oughly scrubbed with tincture of green soap
and water. Scrubbing should be done gently
in order not to traumatize injured tissue.
The scrub-up usually takes about a half-
hour. Following this a five or ten per cent
freshly prepared aqueous solution of chemi-
Nineteen Hundred and Forty-two — February
callj pure tannic acid is sprayed on tbe
burned surfaces. As soon as the first coat
dries a second one is applied. This process
continues until a definite eschar has formed.
The tannic acid eschar is rather thick, insol-
uble and brittle. When it has formed it seals
off the burned nerve endings from air, there-
by stopping pain. As it has been put on a
sterile surface, it reduces the possibilities of
infection during the first two or three weeks.
The most expert exponents of this treat-
ment advocate the removal of the eschar after
three weeks. This empirical time limit was
arrived at by clinical experience. It was
found that after the first three weeks infec-
tion almost invariably began to undermine
the eschar. Due to its insoluble character it
tends to pocket the pus causing sulvescharotic
abscesses.
The removal usually has to be done by
sharp dissection under anesthesia. After it
is off the exposed surfaces are then either
skin grafted or treated with wet dressings un-
til the granulation tissue builds up sufficient-
ly to accept grafts.
When this technique is followed carefully,
and when at the same time attention is paid
to the general care of the patient, the end
results are fairly good. However, it is obvi-
ous that there are some serious drawbacks to
this form of treatment.
In the first place it is frequently not ad-
visable to anesthetize and scrub a large
burned area when the patient is in profound
shock. If, as sometimes happens, the shock
period lasts for twenty-four to forty-eight
hours, it is impossible to thoroughly cleanse
the burned areas. In these cases, either tan-
nic acid is put on top of the infected surface,
or the patient must be subjected to anesthesia
and scrub-up before he is entirely out of
shock.
Secondly, due to the nature of the crust,
tannic acid gives no clue as to the presence
of infection. The first evidence is usually
noted on the chart by a rise in the tempera-
ture curve. In order to find where the infec-
tion is, the eschar would have to be drilled
to tap the pus pocket. Wliile it is true that
infection usually does not develop under the
eschar before the end of the third week,
there are cases where virulent organisms are
25
able to gain a foothold before that period is
up.
Thirdly, it is pretty obvious to anyone
who has handled many large burns that at
the end of three weeks it is impossible to
graft a g-reat many of them. Granulation
tissue has not built up in that length of time,
and skin gi-afts would not remain viable for
long. In such cases, it is necessary to turn to
wet dressings of boric acid, chlorinated soda,
or Dakin’s solution for an undetermined
period until the tissues have built up to the
proper character and level. Thus in certain
deep large burns tannic acid treatment
can only be used for three weeks and then it
is necessary to resort to older forms of treat-
ment that have acknowledged drawbacks.
Tannic acid has a mild detrimental effect
on exposed tissues. It does not tend to pre-
serve all of the viable cells. As a matter of
fact, it has a definite though weak destruc-
tive action. Thus a light second degree burn
is changed to a deeper one and a deep second
degTee burn is frequently converted into a
third degree. This destructive action neces-
sitates skin grafting in the vast majority of
burns and clinical experience has shown that
burns treated with tannic acid are more
prone to form contracture bands than those
treated with certain other substances.
In the last few months the author has re-
ceived verbal communications from several
surgeons who are using the tannic acid treat-
ment that indicate that tannic acid may have
a destructive factor on the liver. Not enough
cases have been observed yet to make a defi-
nite statement. It can be said, however, that
in a few careful autopsies done on patients
dying from burns who had received the tan-
nic acid treatment, there was a necrosis of
the liver closely resembling the picture seen
in animals who had received intravenous in-
jections of tannic acid. A great deal more
work and study will have to be done before
this point can be proven.
In recent years a modification of the tan-
nic acid treatment has been advocated. This
modification consists of spraying on only one
coat of a ten per cent aqueous solution of
tannic acid followed by a 5% aqueous solu-
tion of silver nitrate. The silver nitrate causes
26
an immediate precipitation which brings
about the formation of an eschar within a
few minutes. While it might be advisable to
have an eschar formed rapidly, it is not very
necessary and certainly should not he done
at the expense of the burned area itself. As
there is no way of determining the exact
amount of silver nitrate necessary for the
coni]3lete jDercipitation of the tannic acid, it
is obvious that in the majority of cases an
excess of silver nitrate will be used. This
causes immediate destruction of the exposed
tissues and it is not an exaggeration to state
that when this treatment is used, every sec-
ond degree burn becomes a third and every
third degree burn is deepened. When the
tannic acid, silver nitrate treatment is used,
skin grafting becomes a necessity, which
means a definite increase in poor cosmetic
and functional results.
Salves and ointments as a preliminary
treatment in burns are not fundamentally
sound. There are many of these products on
the market that are supposed to contain vari-
ous chemicals, highly beneficial in stimulat-
ing growth and bringing about antiseptic
conditions. It has been definitely proven
that very few of the antiseptics are capable
of being transferred by an oily base into the
aqueous film surrounding an organism. In
order to accomplish this the antiseptic must
be one which is released from the salve as a
gas which then dissolves in the watery film
surrounding the germ. Thus it is seen that
the potency of the antiseptic becomes greatly
reduced if not entirely destroyed when it is
put up in an ointment.
When a salve is used, daily dressings must
be done. This is a very painful procedure in
most burns. Patients rapidly develop an in-
tense fear of the daily visit of the surgeon
and it is much more difficult to have them
attain that proper mental condition so neces-
sary to the physical response in a convales-
cent patient. This is especially true in chil-
dren where cooperation and cheerfulness are
so important.
Ointments and salves, when kept in con-
tact with skin and tissues over a long period
of time, tend to bring about maceration.
This is due, not to actual invasion by the
ointment, hut rather to the fact that the nor-
The Journal of the Maine Medical Association
mal aqueous excretions cause the waterlog-
ging. When these substances are applied to
a fresh burn surface, they do not prevent the
serous exudate which takes place during the
first seventy-two hours. Thus a serious fluid
loss occurs, which must he replaced. A great
number of the salves on the market advocated
for use in burns have caused extensive
eczema and dermititis. As it is almost im-
possible to keep an ointment confined to the
burned surface, and as normal unburned skin
has definite absorptive powers, it is quite
possible for a toxemia to develop when the
ointment contains some of the mercurials
and picrates. This fact is borne out by a
review of the recent literature which reveals
at least fifteen fatalities resrdting from the
absorption of a substance commonly used in
the treatment of burns. It is generally con-
cluded that most salves, ointments, and soap-
like products are without any definite values
in the first stage of burn treatment.
Wet dressings have been used in the
past a gTeat deal. At the present time, how-
ever, very few surgeons approve of this tech-
nique as an initial treatment. Wet dressings
were originally considered an ideal method
of applying a mild antiseptic to the burned
area. Lister used moist boric acid compresses
exclusively in treating burns. All of the non-
irritating antiseptics have been used by this
method at one time or another. The draw-
backs of this technique as an initial treat-
ment are obvious. It is almost impossible to
keep wet dressings warm and to keep the
liquid from wetting the entire bed. The
patient is thus lying in a cool pool of solu-
tion which is very uncomfortable and un-
doubtedly lowers the patient’s resistance.
Wet dressings have to he changed frequently
and tend to adhere to raw surfaces. The one
beneficial effect of this treatment, the anti-
septic quality, is overwhelmed by the many
drawbacks. At the present time, wet dress-
ings are useful only in infected burns. In
this situation, they do exert a cleansing effect
on the surface, and if kept warm, create a
hvperemia, which is useful in combatting in-
fection.
The water hath has been used many times
in the past and has been discarded. It is not
worth while mentioning this treatment in
this paper.
Nineteen Hundred and Forty-two — February
The treatment of burns with a mixture of
three of the aniline dyes is, in the opinion of
the author, the most modern and logical one.
The ehicacy of this form of treatment should
be judged by a number of factors. These
factors are:
( 1 ) Mortality.
(2) Morbidity.
(3) Life expectancy in the fatal cases in
terms of time.
(4) Complications such as surgical scar-
let, septicemias, and metastatic
abscesses.
(5) Necessity for skin grafting and plas-
tic operations.
(6j The end results from the cosmetic
viewpoint.
The aniline dye treatment has one serious
drawback. It is not an easy form of treat-
ment. It involves a great deal of work on the
part of the surgeon, and will never become
the method of choice for the surgeon who is
too busy to give the necessary time or to the
one who for other reasons does not like to put
in the required hard work. In clinics where
the care of a burned patient is relegated to
the youngest interne or to student nurses, it
has no place. In most cases when it has ap-
parently failed, a study will show that lack
of interest or a lack of ability liavc been the
underlying causes of the failure.
The case records of the Boston City Hos-
pital for the years 1939 and 1940 give the
necessary data to judge this form of treat-
ment according to the criteria as stated
above. In these two years, over five hundred
seriously burned patients were admitted for
hospitalization. In 1939, the mortality was
7.2 per cent, and in 1940, 10.3 per cent.
When these figures are compared to the
mortality as reported for the Johns Hopkins
Hospital by Wharthen for the tannic acid
years of 1927 and 1928, a marked reduction
will be noted. The average mortality for
those two years in Johns Hopkins was thirty-
two per cent. Other clinics have frequently
reported as low a mortality as the Boston
City, but the figures are not based on a suffi-
ciently large series. In another paper, an
analysis of the cases at the Boston City
Hospital will be made covering the years
1919 thru 1940 inclusive. This series is
27
based on approximately 3000 cases. The
mortality during that period in which the
aniline dyes were used was consistently
around ten per cent in spite of a large num-
ber of total bui’us which obviously could not
be saved.
Morbidity cannot be stated in percentages.
It is sufficient to state that the vast majority
of third degree burns of one-third of the body
area or less, treated with the aniline dves,
were not confined to bed unless the feet were
involved. Most of the patients were allowed
to sit up, were given bathroom privileges,
and were able to care for themselves to a
large degree. Toxemia only developed if the
lesions became septic, and rapidly cleared
when the sepsis was controlled.
The average life expectancy of the fatal
burn cases in the above-mentioned series was
142 days. The value of such a prolonged
period is obvious. It indicates that patients
were not being lost in the first seventy-two
hours from shock and were not dying from
an acute infection in the first month. This
lengthy period gives both the patient and the
surgeon ample time to utilize all the known
supportive treatments. The satisfaction to
the patient is of course nil, but to the sur-
geon, a death occurring after five months of
hard work does not bring a feeling of guilt
for inadequate care. The causes of death
after such a period are multiple, but usually
depend upon factors which cannot be com-
batted by even the most meticulous and well-
trained surgeon. Conditions such as old age,
the lack of reserve forces of childhood, and
pre-existing diseases are causes that human
forces cannot change.
Complications arising in burn patients
treated with the aniline dyes are rare. Un-
der the older forms of treatment, surgical
scarlet was a not uncommon disease. No case
of it was observed in any of the burns at the
Boston City Hospital treated with gentian
violet or the aniline mixture.
This absence is due to the specific action
of these aniline dyes against the gram posi-
tive organisms. The incidence of septicemia,
metastatic abscess, ulceration of the intestine,
kidney damage, and the many other compli-
cations predominant under other forms of
treatment is very low.
This again is due to the reduction of
28
surface infection by the action of the dyes.
Most of the complications arising after the
first week following the burn are due to
infection.
Skin grafts are necessary in extensive
burns when all of the epithelium has been
destroyed. It is inadvisable to wait for new
epithelium to grow in from the edges. The
growth is slow, granulation tissue builds up
too high, and scar tissue contraction bands
make their appearance in the granulating
surface. However, in most of the third
degree burns, all epithelium is not destroyed.
There are many islands of epithelium at the
base of the hair follicles and the sweat Hands
O
which usually escape destruction, as these
structures are beneath the dermis. If these
many islands of epithelium can be kept free
from infection, they will grow up through
the granulating tissue and spread a new layer
of thin pink flexible skin over most of the
third degree areas. It is quite important
that the viability of these cells is not affected
and that no solution or ointment should be
used on them that is irritating or harsh. The
aniline dyes exert no deleterious influence on
living cells. Even in large third degree burns
such as one of the entire back, it has been
found necessary to skin graft in only about
one-fifth of the cases that formally came to
this procedure. When new epithelium covers
a burn at a fairly early stage, contracture
bands do not develop, and if patients are
compelled to heal in the best possible posi-
tion, webs and adhesions do not develop.
The treatment with the aniline dyes was
brought out in 1934 by Aldrich. Gentian
violet had been his method of choice, but
gentian violet had one inherent weakness —
it was not a specific antiseptic against gram
negative organisms. This led to the annoy-
ing complication of having the eschar ele-
vated by coli-bacillus pus somewhere after
the first week. A search was then made
through all the aniline dyes for some one
substance that would contain the beneficial
effect of gentian violet with a high specific
action against the gram negatives. Ho one
dye could be found. It was discovered, how-
ever, that a mixture of three of the aniline
dyes, namely, crystal violet, brilliant green,
and neutral acriflavin, when combined in
certain proportions, developed a synergistic
The Journal of the Maine Medical Association
action. This combination formed a light,
tough, flexible, soluble eschar as did the
gentian violet and yet exerted a powerful
antiseptic action against gram negatives and
gram positives. In the test tube in broth,
this mixture will not allow a gram positive
to grow in concentrations of one to one mil-
lion. In concentrations of one part of the
dye mixture to ten thousand parts of broth,
both gram positives and gram negatives are
killed. It is used on burned areas in a 2%
aqueous solution. A toxicity study was then
conducted. Hone of the experimental ani-
mals used showed any reaction to the mix-
ture, and it has since been used on well over
one thousand burns without any noticeable
side action.
When a burned patient is first admitted,
the initial attention is given to the shock
phase. In most cases, it is usually possible
to remove their clothing and place them in
bed under a cradle without disturbing them.
If the patient is in extremis, he is simply
placed in bed, wrapped up in warm blankets,
or placed under an electric heating blanket,
the clothing not being disturbed.
Shock is handled by the four fundamentals
of heat, rest, fluids, and the control of pain.
Every patient with a burn of one-fifth of the
body area or more is considered a shock
patient whether or not he shows symptoms
and physical signs on admission.
The treatment of the burned areas is be-
gun as soon as it is considered safe to do so.
Ho preliminary scrub-up is done on an un-
treated burn. If there are any loose shreds
of skin, these may be trimmed away. All
blebs are excised. Ho effort is made to do a
complete debridement. It is necessary to
remove any oily substance or salve that has
been applied as a first aid measure before
the aqueous solution of the dyes can be
applied. A sponge sopping wet with ether
is patted on the oily areas gently until they
are perfectly clean. It is not necessary to
use an anesthesia for this procedure.
A two per cent aqueous solution of the
aniline dyes is sprayed on the burned sur-
face. As fast as one coat dries, another is
reapplied. This process is continued until a
light, flexible eschar is formed. All pain
ceases usually after the first coat has been
applied. The patient is placed in bed under
29
Nineteen Hundred and Forty-two — February
a cradle in which the temperature is main-
tained at between 8d degrees and 88 degrees
Fahrenheit. Once the eschar is formed, no
further application of dyes is needed, but
the eschar must be examined at least once
a day for signs of softening. This eschar,
unlike the one obtained by tannic acid, is
soluble.
If an area becomes infected, the eschar
directly over it becomes soft and moist. Such
a spot is elevated with tissue forceps and
trimmed away with scissors. The underlying
area is dried with a sterile sponge, and the
dye reapplied. This process of picking and
respraying continues until granulation tissue
has been built up to the point of accepting
a skin gTaft or until epithelium begins to
spread throughout the gTanulated tissue.
In an ideal burn — that is, a burn that
can be kept uppermost and exposed to air
and is not involved in body secretions and
excretions — the eschar remains dry and
sterile throughout until epithelium has
spread under it. Frequently, the eschar can
be elevated in one piece at the end of a heal-
ing period revealing a thin pink scar with
no tendency to contracture.
Large burns, however, are usually not
ideal. A burn of thirty per cent or more of
the body area usually involves both the front
and back of the body and necessitates the
patient lying on a burned surface. This, plus
the contact with the bed, causes an imperfect
eschar to develop. In most large burns, an
orifice of the body lies either in or close to
the burn surface. This brings about gross
contamination many times a day, which is
almost certain to infect the area under the
eschar. This is especially true of children
who refuse to use the bed pan and who con-
stantly soil themselves and soak their eschar
in urine.
This contamination makes it essential to
watch the eschar very closely. If all infected
areas are removed at least once a day, the
superficial sepsis can never bring about a
bacterial invasion. Where there is no infec-
tion or only a superficial one, there is never
any real toxemia.
In third degTee burns, usually, the islands
of epithelium at the base of the hair follicles
and sweat glands are not destroyed as they
are beneath the skin. If sepsis can be pre-
vented to a marked extent, these tiny islands
will spread and cover even a large burn.
The end result is a soft, thin, pliable scar
that gives a good cosmetic result and does
not lead to the formation of contracture
bands.
The drawbacks to the aniline treatment are
few but are definite. This type of treatment
is not an easy one. It requires painstaking
effort to observe the eschar, and frequently
a large burn will occupy an hour of the
surgeon’s time in removing septic areas.
There is no antiseptic strong enough to kill
off germs under conditions of gross contami-
nation that is tolerated by the body. With
the aniline treatment, a surgeon can stay a
short way ahead of gross infection if he is
willing to put in the necessary time and
effort. It is this feature that condemns this
form of treatment in the eyes of most sur-
geons who have tried it and who have given
it up. This drawback is not as much an
accusation of the form of treatment as it is
the surgeon caring for the case. If the mor-
tality can be reduced from the average of
thirty per cent down to eight per cent, it is
certainly well worth the effort needed to
bring about the reduction.
It has been the experience of the author
during the past ten years of clinical work on
bums that no one form of treatment can be
used through the entire period of convales-
cence on every large burn. The period begin-
ning with the inspection of the burn and
ending with complete healing can be divided
into three parts. The first part covers the
period of shock. As stressed before, this is
a very important phase and must be dealt
with by shock treatment and not by treat-
ment on the burn. When this period is over,
there is a definite need for a substance that
will act as an antiseptic and form a light,
flexible eschar. Up to the present time, the
dye mixture is the best known agent in bring-
ing about the desired result. This period has
no special time limit. The depth of the
burn and the ability to heal makes each
patient an individual case, and only averages
can be given when attempting to evaluate
the time element. An average in a large
series of bums would be about one month.
Certain bums will heal very rapidly, and
others will cover a period of many months.
30
At tlie end of the second phase of healing,
that is, when the gi’anulation tissue has
built up to the point where it will accept a
skin graft or where many small islands of
epithelium are beginning to spread through
the burned areas, the aniline dye treatment
should be discontinued. The third phase
represents a different problem, this problem
being to stimulate the epithelium that is
present in the burned surface or to artifi-
cially cover part or all of it with epithelium
from some other area of the body. Skin
grafting will not be discussed in this paper.
The surgeon may choose the type of gvaft he
considers best and may treat it with the
technique that he approves.
Many substances have been credited as
having inherent powers of epithelial stimu-
lation. Most of these substances are put up
in the form of a salve, and clinical observa-
tion indicates that a few of them actually
cause a more rapid spread of epithelium. It
has been the experience of the author that
cod liver oil is a definite stimulator to the
growth of new skin. This power is sup-
posed to be due to the vitamin content of the
oil. While cod liver oil cannot be called an
antiseptic, it is a well-known fact that it is
sterile at all times, even when exposed to air.
It has a definite bacteriostatic action, with
possibly a mild bactericidal one. The high
vitamin A and D content of the oil seemingly
aids the islands of epithelium to grow faster
than one would normally expect. Cod liver
oil, however, is a messy substance to use as
a dressing. It saturates the bed clothing and
has a rather unpleasant odor. In a recent
series of cases, the author has used a cod
liver oil ointment containing seventy ])er cent
cod liver oil, thirty per cent wax, and small
amounts of zinc oxide, benzoin and ])benol.
This ointment has only a slight odor and is
of a good consistency. It spreads easily on
gauze. Because of the wax base, there is no
tendency toward maceration. It contains a
sufficiently high concentration of cod liver
oil to insure a high vitamin potency. The
zinc oxide, benzoin and phenol bring about
a slight drying and antiseptic action. The
dressings should be changed twice a day in
hospitalized cases and once a day in ambu-
latory patients.
Usually, within a few days after this
The Journal of the Maine Medical Association
treatment of the final stage has begun, the
epithelium spreads remarkably fast and be-
gins to cover all the raw surfaces. These
dressings should be continued until healing
is complete.
Foemula of Dymixal
A mixture is made up of the following-
materials, the parts being given by weight :
Crystal violet (hexamethyl pararosani-
line hydrochloride ) 1.5
iSTeutral acriflavine (the base of 3 ;6-
diamino-lO-niethyl acridinum chlo-
ride mono-hydrochloride) 0.75
Brilliant green (the sulphate of tetra-
ethyl diamino triphenyl carbinol
anhydride) 1.0
In practice, 6.5 grams of this mixture is
dissolved in 250 cc. of water and the result-
ing solution is aj^plied to the burned surface
or surfaces with a suitable vaporizer, ato-
mizer, spray or the like.
The Dymixal is distributed by the McUeil
Laboratories, 2900 Forth 17th Street, Phila-
delphia, Pa.
The cod liver oil ointment mentioned is ■
manufactured by the E. L. Patch Company
of Stoneham, Mass.
Summary
(1) A brief history of the treatment of
burns is given.
(2) The theories as to the cause of the
toxemia and death occurring in burned pa-
tients are reviewed.
(3) The treatment of shock should be
carried out before the l)urned areas them-
selves are given consideration.
(I) Tannic acid and the aniline dye treat-
ments are discussed and compared.
(5) The results obtained on burned pa-
tients entering the Boston City Hospital
between 1919 and 1910 are analyzed.
Bibfiography
1. Pack, G. T., and Davis, A. H.; Burns, Phila-
delphia, 1930, J. B. Lippincott Company.
2. Davidson, E. C. : Tannic Acid in the Treat-
ment of Burns, Surg., Gynec. & 01)St., 41:202-
221, 1925.
Continued on 'page Jf2
Nineteen Hundred and Forty-two — February
31
Looking Back Fifty Years^
By W. Edgae. Siecock, i)., Caribou, Maine
The first of August has arrived and I sup-
pose that the Medical Board of the Cary
Hospital expects some sort of a paper from
me.
I have been looking back in my miiid over
half a century of busy practice to see if I
could think of any cases or happenings in the
practice of medicine that would be of any
interest to you.
I began the practice of medicine the first
of July, 1891, ill this town in the same place
where I now live, it being my father’s home,
where I had lived since I was six years old.
I had been studying medicine four years,
having attended three-year medical courses
at Bowdoin. The way we used to do in those
days was to register with some doctor in ac-
tive practice, and when we were not in the
medical school we would be in his office, visit
cases with him, see how he diagnosed, ex-
amined and treated his cases, and we were
supposed to read physiology, chemistry, anat-
omy, medicine and recite to him.
The course at Bowdoin was three years
but I was out my third year on account of the
death of my father and a sister (father died
of pneumonia and sister of tuberculosis of
the lungs). During that year I was in the
office of my preceptor and made many calls
on his patients for him.
My preceptor, the late Charles F. Thomas,
father of our Doctor Charles, was a true,
typical country doctor, of a wonderful per-
sonality; cheerful, strong, hard-working, tire-
less, and self-sacrificing. His patients came
first and he gave to them the best he had.
Charles F. Thomas was beloved by his pa-
tients and the citizens of Caribou. He was
interested in the schools and everything that
was for the advancement of Caribou, and he
was also the best after dinner speaker in
tovm, — as A. M. York used to say ‘Hy God”.
What a difference there is today in the
treatment of diseases than when T started to
practice in 1891. At that time serum for
diphtheria was not discovered and all we had
to combat it with was supportive treatment
tincture of choloride of iron and whiskey.
How well do 1 remember a little girl of three
years, she lived on ISweden Street, who had
what we then called membranous croup. Her
breathing kept growing harder and louder,
and color of nails blue, — as a last resort I
did a tracheotomy, how the color came back
to her face and how quietly she rested that
night, but the disease soon went beyond my
tube and she died.
In those days diphtheria wiped out whole
families. When antitoxin was first used I
remember how cautious we were about using
it. Diagnoses then were made on symptoms
and appearance of the throat. There were no
laboratories in the county and by the time
we got a report from the state chemist at
Augusta, it was usually too late to give the
injection. I can think of two cases; — one in
the village and one in Perham whom I feel
sure would be living today had I given anti-
toxin sooner and in larger doses.
Fifty years ago what did we have for the
treatment of pneumonia and tuberculosis ?
In pneumonia if the involvement was not too
much and the patient had a good heart the
disease would run its course in five to eight
days. The j>atient was kept in bed, symptoms
were treated as they arose, poultices applied
to the chest, some doctors had the courage to
use cold on the chest but most of them used
heat. Stimulants were given with the hope
that they would live long enough for the dis-
ease to run its course and resolution take
place. Pneumonia was called “the death of
the old man.”
In tuberculosis a change of climate was
advised when possible which was not often.
There were no sanatoriums where rest, forced
feeding, fresh air and serums were given ; the
contagiousness of the disease was not realized
and very few precautions were taken against
the spread of it.
T^^q)hoid fever, of which there used to be a
great number of cases each year, was gener-
* Read before the Medical Board of the Cary Hospital, Caribou, Maine, by W. Edgar Sincock, M. D.,
August 5, 1941.
32
The Journal of the Maine Medical Association
ally traced to the Aroostook River water or
some well or stream from which drinking
water was obtained. Presque Isle sewerage
helped to pollute our river water and there
was no treatment of it by cholorine gas as
there is today. Cases of typhoid fever were
diagnosed by objective symptoms; the Widal
test was not used here. Today there is hardly
a case of typhoid fever on account of pre-
ventive serum treatment and purification of
water supply.
Let’s look at the treatment of diabetes mel-
litus today and fifty years ago. The diagnosis
is the same. There are the same general
symptoms, of course, polyuria with sugar in
the urine, glucose; the cause was unknown
but it was attributed to nervous disturbances
such as mental or emotional excitement or
anxiety; sometimes to injuries to the head or
as the result of acute diseases or to over in-
dulgence in carbohydrates. The main treat-
ment was cutting out starch and sugars and
the main dnig used was opium in some form
to control the sugar. By this means the dis-
ease was held in check and in some cases the
urine would clear up. I remember the case
of an old man I had, a mason by trade, who
was able by these means to live and work for
a long period of years and was quite an old
man when gathered to his fathers. There was
no other treatment until 1920 when Banting
and Best discovered insulin which revolu-
tionized the whole treatment of diabetes. It
is on record that 50% of diabetic patients
previous to this discovery used to die of coma,
25% of phthisis or pneumonia and the re-
mainder of Bright’s disease, hemorrhage, gan-
grene, carbuncle or other complications. At
the present time by the proper use of insulin
these people can live out their natural life-
time.
There was no antidote for spinal menin-
o;itis, no serum for tetanus. Ho one had
heard of the curative power of liver in the
treatment of anemia, all we relied on in per-
nicious anemia was arsenic. Surgery was the
only real treatment for cancer whereas to-
day radium and X-ray help a great deal, but
as yet the future holds the cure.
A new microbe killer has been discovered
within the last few years which has revolu-
tionized the treatment of a great many dis-
eases ; sulfanilamide. Septic sore throat, in-
flammation of tubes and ovaries, gonorrhea,
and pneumonia are some of the diseases
which are greatly benefitted by this prepara-
tion. I have had some cases of pneumonia
during the past two years which were cured
so quickly by sulfathiazole, the latest chemi-
cal cousin of sulfanilamide, that it was hard
to make the families believe that the cases
were any thing more than a simple cold. I
have not treated many cases of gonorrhea
with sulfathiazole but if results are anything
like what is claimed for it, certainly it is the
greatest boon to man that has happened dur-
ing the last fifty years.
It is claimed that there are four cases of
gonorrhea to one of syphilis, but syphilis is
a deadly disease and while the armanent for
its treatment has been greatly increased dur-
ing the past half century still if the doctors
would put more stress on the treatment and
the people who have the disease would follow
the doctors’ directions better there would be
much less syphilis in the world today. The
premarital medical examination which has
just become a law will be, I think, an aid in
getting rid of this disease. I have only ex-
amined two couples under this law but they
did not seem to think it was any hardship
and were perfectly willing for the blood test
to be made.
The prevention and treatment of diseases
of children has changed a great deal. We had
vaccination for smallpox but other than that
there were no serums for children’s diseases.
As long ago as when I was a child bovine
virus for smallpox was quite expensive and
humanized virus was used a great deal. I
remember when I was four years old after I
had been vaccinated and had a good scab with
plenty of pus under it Dr. Decker of Fort
Fairfield, where we then lived, took me with
him from house to house and vaccinated chil-
dren and grown people from my arm. I can-
not remember how he did it but it is safe to
assume that he used the same needle or lance
for every one without any disinfectant. I
don’t believe there was ever a happier kid
than I when he lifted me down from his old
buggy at my parents’ door that night and
gave me a quarter of a dollar.
If you took time and were interested to
look up in some of the medical books of fifty
years ago you would not find any mention of
33
Nineteen Hundred and Forty-two — February
hypertension. There were no blood pressure
instruments and all we knew about it was
what we learned by the sense of touch. To-
day the severity of our case can be exactly
told. A study of the etiology and causal fac-
tors and strict attention to diet will do a great
deal, but there is not yet a real antidote for
high blood pressure. I have always believed
that high blood pressure was due either to
disease of the kidneys or some disease or
change of the circulatory system. Most every
drug house in the country has some pill for
hypertension but I cannot say that I have had
any success or benefit with any of them for
my patients. I believe that some doctors in
the Indianapolis City Hospital are working
on a new remedy which if successful will
revolutionize the treatment of hypertension.
There is an interesting article on this sub-
ject in the August number of The Headers
Digest.
When I began to practice medicine all the
maternity cases were taken care of in the
homes, as there were no hospitals or trained
nurses, but in almost every neighborhood
there would be some woman a little more cap-
able than the others who would be sent for
to help the doctor. I have slept a good many
times in my old sleigh or buggy on the home
journey after a twenty-four hour or longer
stay, but my faithful horse would usually
land me on my barn floor without any acci-
dent. A few times I remember waking up on
the wrong road or in a field. When pituitrin
came to our help, about thirty years ago,
these long stays were shortened considerably.
When I first began to practice the obstetrical
fee was $5.00, but money would buy more
then and expenses were nothing compared to
what they are today. If all my babies were
living and in a town by themselves that to^vn
would have a population of 4,225, about half
the population of the town of Caribou.
And now, Members of the Medical Board
of Cary Hospital, I have tried in this short
paper to show some of the changes and ad-
vancements in medicine during the fifty
years of my practice ; when you have arrived
at my age you will have seen, no doubt, as
many more and perhaps more important
changes.
As new drugs and antidotes for diseases
are discovered and greater knowledge and
skill in surgery attained the span of human
life will grow longer; and that brings me
to my final point, for the past ten years I
have thought that there has not been enough
written about the care and treatment of the
old man, and looking ahead to the future I
hope that you will find on the shelves of the
doctors’ libraries just as many books and
pamphlets about the care and treatment of the
old man as are now found about the care and
treatment of the child : — for we all know the
truth of the saying ^‘once a man twice a
child.” This is the way Shakespeare, the
great delineator of life, puts it :
“All the world’s a stage,
And all the men and women merely players;
They have their exits and their entrances;
And one man in his time plays many parts.
His acts being seven ages. At first the infant.
Mewling and puking in the nurse’s arms.
And then, the whining school-boy, with his satchel
And shining morning face, creeping like snail
Unwillingly to school; And then the lover;
Sighing like furnace, with a woeful ballad
Made to his mistress’ eyebrow; then the soldier.
Full of strange oaths, and bearded like a pard.
Jealous in honour, sudden and quick in quarrel.
Seeking the bubble reputation.
Even in the cannon’s mouth; and then the justice;
In fair round belly, with good capon lined
With eyes severe and beard of formal cut.
Pull of wise saws and modern instances.
And so he plays his part; The sixth age shifts
Into the lean and slippered pantaloon;
With spectacles on nose, and pouch on side;
His youthful hose well saved, a world too wide
For his shrunk shank, and his big manly voice
Turning again toward childish treble, pipes
And whistles in his sound; Last scene of all.
That ends this strange eventful history.
Is second childishness, and mere oblivion;
Sans teeth, sans eyes, sans taste, sans everything.”
Undiagnosed tuberculosis is present in
patients admitted to mental institutions in a
fairly large percentage. In addition to tbese,
a relatively large percentage of patients de-
velop tuberculosis while in residence, again
without their disease being recognized. —
M. PoLLAK, et ah, Amer. Bev. of Tuber..
March, 1941 .
34
The Journal of the Maine Medical Association
Recommendations to All Physicians with Reference to the
National Emergency
I. Medical Students
A. All students holding letters of accept-
ance from the Dean for admission to medical
colleges and freshmen and sophomores of
good academic standing in medical colleges
should present letters or have letters pre-
sented for them hy their deans to their local
boards of the Selective Service System. This
step is necessary in order to he considered
for deferment in Class II-A as a medical
student. If local boards classify such stu-
dents in Class I-A, they should immediately
notify their deans and if necessary exercise
their rights of appeal to the Board of Ap-
peals. If, after exhausting such rights of
appeal, further consideration is necessary, re-
quest for further appeal may be made to the
State Director and if necessary to the Na-
tional Director of the Selective Service Sys-
tem. These officers have the power to take
appeals to the President.
B. Those junior and senior students who
are disqualified physically for commissions
are to be recommended for deferment to
local boards by their deans. These students
should enroll with the Procurement and As-
signment Service for other assignment.
C. All jmiior and senior students in good
standing in medical schools, who have not
done so, should apply immediately for com-
mission in the Army or the Navy. This com-
mission is in the grade of Second Lieutenant,
Medical Administrative Corps of the Army
of the United States, or Ensign H. V. (P)
of the United States Navy Deserve, the
choice as to Army or Navy being entirely
voluntary. Applications for commission in
the Army should be made to the Corps Area
Surgeon of the Corps Area in which the ap-
plicant resides and applications for commis-
sion in the Navy should he made to the Com-
mandant of the Naval District in which the
applicant resides. Medical R. O. T. C. stu-
dents should continue as before with a view
of obtaining commissions as First Lieuten-
ants, Medical Corps, upon graduation. Stu-
dents who hold commissions, while the com-
missions are in force, come under the
jurisdiction of the Army and Navy authori-
ties and are not subject to induction under
the Selective Service Act. The Army and
Navy authorities wfill defer calling these offi-
cers to active duty until they have completed
their medical education and at least 12
months of interneship.
II. Recent Geaduates
Upon successful completion of the medical
college course, every individual holding com-
mission as a Second Lieutenant, Medical Ad-
ministrative Corps, Army of the United
States, should make immediate application
to the Adjutant General, United States
Army, Washington, D. C., for appointment
as First Lieutenant, Medical Corps, Army of
the United States. Every individual holding
commission as Ensign H. V. (P), U. S.
Navy Reserve, should make immediate appli-
cation to the Commandant of his Naval Dis-
trict for commission as Lieutenant (J. G.)
Medical Corps Reserve, U. S. Navy. If ap-
pointment is desired in the grade of Lieu-
tenant (J. G.) in the regular Medical Corps
of the U. S. Navy, application should be
made to the Bureau of Medicine and Sur-
gery, Navy Department. Washington, D. C.
III. Twelve Months Inteenes
All internes should apply for a commission
as First Lieutenant, Medical Corps, Army of
the United States, or as Lieutenant (J. G.),
United States Navy or Navy Reserve. Upon
completion of 12 months interneship, except
in rare instances where the necessity of con-
tinuation as a member of the staff or as a
resident can be defended by the institution,
all who are physically fit may he required to
enter military service. Those commissioned
may then expect to enter military service in
their professional capacity as medical offi-
cers ; those who failed to apply for commis-
sion are liable for military service under the
Selective Service Acts.
Nineteen Hundred and Forty-two — February
IV. Hospital Staff Members
Internes with more than 12 months of in-
terneship, assistant residents, fellows, resi-
dents, junior staff members, and staff mem-
bers under the age of 45, fall within the pro-
visions of the Selective Service Acts which
provide that all men between the ages of 20
and 45 are liable for military service. All
such men holding Army commissions are sub-
ject to call at any time and only temporary
defer-ment is possible, upon approval of the
application made by the institution to the
Adjutant General of the United States x\rmy
certifying that the individual is temporarily
indispensable. All such men holding ISTaval
Reserve commissions are subject to call at
any time at the discretion of the Secretary of
the Havy. Temjiorary deferments may be
granted only upon approval of applications
made to the Surgeon General of the Vavy.
All men in this category who do not hold
commissions should enroll with the Procure-
ment and Assignment Service. The Procure-
ment and Assignment Service under the
Executive Order of the President is charged
with the proper distribution of medical per-
sonnel for military, governmental, industrial,
and civil agencies of the entire country. All
those so enrolled whose services have not been
established as essential in their present ca-
pacities will be certified as available to the
Army, Uavy, governmental, industrial, or
civil agencies requiring their services for the
duration of the war.
V. All Physicians Under Forty-Five
All male physicians in this category are
liable for military service and those who do
not hold commissions are subject to induction
under the Selective Service Acts. In order
that their service may be utilized in a pro-
fessional capacity as medical officers, they
should be made available for service when
needed. Wherever possible, their present po-
sitions in civil life should be filled or pro-
visions made for filling their positions, by
those who are (a) over 45, (b) physicians
under 45 who are physically disqualified for
35
military service, (c) women physicians, and
(d) instructors and those engaged in research
who do not possess an M. D. degree whose
utilization would make available a physician
for military service.
Every physician in this age group will be
asked to enroll at an early date with the Pro-
curement and Assimiment Service. He will
o
be certified for a position commensurate with
his professional training and experience as
requisitions are placed with the Procurement
and Assignment Service by military, govern-
mental, industrial or civil agencies requiring
the assistance of those who must be dislocated
for the duration of the national emergency.
VI. All Physicians Over Forty-Five
All physicians over 45 will be asked to en-
roll with the Procurement and Assignment
Service at an early date. Those who are es-
sential in their present capacities will be re-
tained and those who are available for assigu-
ment to military, governmental, industrial or
civil agencies may be asked by the Procure-
ment and Assignment Service to serve those
Agencies.
The maximal age for original appointment
in the Army of the United States is 55. The
maximal age for original appointment in the
Haval Reserve is 50 years of age.
Frank H. Lahey, M. D., Chairman
Harvey B. Stone, M. D.
James E. Paiillin, M. D.
Harold S. Diehl, M. D.
C. Willard Camalier, D. D. S.
Sam F. Seeley, M. D.,
Executive Officer
All inquiries concerning The Procurement
and Assignment Service should be sent to
The Executive Officer, 5654 Social Security
Building, 4th and Independence Avenues,
SW, Washington, D. C., and not to indi-
vidual members of the Directing Board or of
committees thereof.
36
The Journal of the Maine Medical Association
Editorial
The Price of Peace
Did thatj fateful Sunday in December,
when Japan struck with all her hideous fury,
the climax of careful planning over many
years, bring to the people of this ISTation an
awakening from their foolish dream of safety
and false security ? Did the humiliating and
pitiful fact that we had been outwitted by the
rulers of Japan, until they were ready to let
loose the horrors of war, convince the country
as a whole that ours had been a fool’s para-
dise? Men whose opportunities and experi-
ences warranted strict heed to their warnings
had been over-ruled by believers of the policy
of appeasement. Her Axis partner unable to
supply J apan with the needed supplies for
the conduct of war, trusting and misguided
gentlemen in the United States bent over
backwards to make up the deficit and the
diplomats, not to be outdone in generosity,
afforded the precious time required for full
preparations and when it looked as if the cat
might get out of the Ijag we had Kurusu di-
rect from Tokyo as the special representative
from the Son of Heaven. Theorists had pre-
dicted for many years that war would not
come, if it did we had an ocean on each side
of us, and it was argued, why should the fight
of Europe concern us? War did come and it
came with its messages of death and destruc-
tion with machines and materials we helped
to make. Have we even now arrived to the
bitter reality that to save America and every
other country believing in the rights of men
to live as life should be lived we must fight
as never before in the history of so-called
civilization ?
Vast as our resources are, great as is our
technical skill and vast as is the potential
and actual wealth of this country all this
means nothing unless transmitted into the
modern mechanisms of defense and attack
and the trained forces to operate them. The
avowed hatred of the rulers of Japan toward
the white races has culminated in an all-out
effort to drive ail but the Japanese from the
rich countries of the Far East. Germany
with her openly avowed plan for a new order
in Europe, with nation after nation the out
and out slaves of the conquerors, invites the
question, what is the price of peace? It also
may be asked, what is peace and is it worth
the price ?
Peace, as so aptly states the New England
J ournal of Medicine, may remain the goal of
our ambitions, but it is a higher goal because
we know now that it represents a positive
virtue and not a passive state. Peace is the
final objective of our current endeavor; but
it must be attained by aggressive action, it
must be cultivated and consolidated and fos-
tered, and it must be constantly defended
by force — forever, as far as our pres-
ent minds can reach. When this objective is
attained, then can we truly say that, because
of our determination to have it so, there may
be peace on earth, to men of good will.
There can be but one answer to the ques-
tion and that must come from a unified
people and peoples else we drink the bitter
dregs of humiliation and defeat as has been
the fate of nation after nation. Physical in-
vasion of this country may be an impossibil-
ity but does any person with a modicum of
common sense believe that the axis group re-
lies on that and that alone ? Every possible
plan and scheme to cripple us by sabotage,
treachery and trickery has not been neglected.
Witness the desperate efforts of Japan to cut
the supply of rubber, tin and other materials
required to build and operate the mecha-
nisms we must have or perish. The price we
must and will pay for success will be far, far
less than that imposed by a victorious Axis
cabal. The brutal coalition against the Allied
nations knows full well the power of the
forces that will ultimately be directed against
them ; the price of peace is even beyond esti-
mation in effort, sacrifice and cost but if there
is any doubt on the point of our willingness
and ability by any Axis leader we refer him
to the remark of Winston Churchill. “What
kind of people do they think we are ?”
Nineteen Hundred and Forty-two — February
37
Organization Section
Emergency Medical Service for Medical Defense
State of Maine
Emergency medical services for civilian
defense are now being matured as rapidly as
possible, consistent with the magnitude
of the work and the novelty of the service as
it is developing. The following list will show
the set-up as it has been developed and two
meetings of the county chiefs with the State
Director, Dr. Allan Craig of Bangor, have
been held. It can safely be said there is no
confusion or doubt in the minds of those who
have been selected to attend to this task and
as plans and advice come from proper head-
quarters they will be carried into effect.
Chief of Emergency Medical Service for the
State of Maine
Allan Craig, M. D., Bangor.
County Chiefs of Emergency Medical
Service
Androscoggin — M. S. F. Greene, M. D.,
Lewiston, Maine.
Aroostook — Frank H. Jackson, M. D.,
Houlton, Maine.
Cumberland — Roland B. Moore, M. D.,
203 State St., Portland, Maine.
Franklin — James Reed, M. D., Farming-
ton, Maine.
Hancock — ^Ralph W. AVakefield, M. D.,
Bar Harbor, Maine.
Kennebec — Clarence R. McLaughlin,
M. D., Gardiner, Maine.
Knox — James Carswell, M. D., Camden,
Maine.
Lincoln — Robert Belknap, M. D., Damar-
iscotta, Maine.
Oxford — Garfield G. Defoe, M. D., Dix-
field, Maine.
Penobscot — Harrison L. Robinson, M. D.,
136 Hammond St., Bangor, Maine.
Piscataquis — M. C. Bro^vn, M. D., Dover-
Foxcroft, Maine.
Sagadahoc — E. M. Fuller, M. D., 108
Front St., Bath, Maine.
Somerset — W. S. Stinchfield, M. D.,
Skowhegan, Maine.
Waldo — Sumner Pattee, M. D., Belfast,
Maine.
Washington — 0. F. Larson, M. D.,
Machias, Maine.
York — David Dolloff, M. D., 13 Crescent
St., Biddeford, Maine.
State Advisory Council for Dr. Craig
The President of the Maine Medical Asso-
ciation.
The President-elect of the Maine Medical
Association.
The Secretary of the Maine Medical Asso-
ciation.
The President of the Maine Hospital Asso-
ciation.
Director of Bureau of Health and Welfare.
The President of the Maine State Kursing
Association.
The President of the Maine Dental Asso-
ciation.
The President of the Maine Pharmaceuti-
cal Association.
Chief of Emergency Dental Service
for the State of Maine
Fred Maxfield, D. D. S., F. A. C. D.,
Bangor.
38
For the availnieiit of professional service
and conijDactness the State will have fonr di-
visions, with three hospital Districts.
1. Medical Men
2. Hospitals
1. Portland
2. Lewiston
3. Bangor
3. Nurses
4. Dentists
Chief of Eynergency Hospital Services
Stephen S. Brown, M. D., Maine Gleneral
Hospital, Portland.
Each County is to have available for ad-
vice and distribution of nursing services, a
Nurse Leader and as soon as the appointees
The Journal of the Maine Medical Association
are designated County Chiefs will be notified.
It is possible at this time to make merely a
preliminary report and survey for as develop-
ments occur and requirements present them-
selves they will be fitted into the plans and
preparations now being carefully considered.
At first glance the plans may appear a little
complicated but this is not a fact. The Chief
Medical Director, Dr. Craig, is very anxious
that Maine does not duplicate the mistakes
and confusion that have followed premature
plans and efforts to place them in operation.
It is planned in the March issue of the
J ouRNAL to furnish as complete and authen-
tic information as is possible. While the term
emergency medical service is employed it can
well be remembered that emergencies, if they
occur, become less formidable if one is PRE-
PARED.
From the Secretary's Office
To the Members of the Maine Medical Asso-
ciation:
I am pleased to inform you that Brig. Gen.
John G. Towne, Medical Corps, of Water-
ville, has accepted the appointment as Chair-
man for the State Medical Committee of Pro-
curement and Assignment Service.
I want to call your attention to two articles
of special interest to every member of our
Association, which are published elsewhere
in this issue.
First — the article. Recommendations to
all Physicians with Reference to the Na-
tional Emergency. This material submitted
by the Procurement and Assignment Service
^Flarifies quite largely the demands which
will be made upon the medical profession.”
Second — the article. Emergency Medical
Service of Medical Defense, State of Maine.
This preliminary report will be followed by
more detailed reports in future issues of the
J OURN AL.
Have you paid your 1942 State and
County dues ? If not — why not pay them
now and help your County Secretary put
your County Society on the 100% Paid-Up
Membership List ? In accordance with a vote
of the House of Delegates in session at York
Harbor, Sunday, June 22, 1941, “Members
who have entered the Service are exempt
from the payment of dues while in the Ser-
vice.”
Frederick R. Car,ter, M. D.,
Secretary.
Nineteen Hundred and Forty-two— February
39
Necrologies
Walter Whitman Hendee, M. D.,
1889-1942
Walter Whitman Hendee, M. D., of Vassalboro,
died January 13, 1942, at the Veterans Administra-
tion Hospital, Togus, following an illness of about
three months.
Doctor Hendee was born in Augusta, March 28,
1889, the son of Edwin C. and Florence Hendee.
He attended local schools in Augusta, Cony High
School, Bowdoin Medical School, and was grad-
uated from the Boston College of Physicians and
Surgeons in 1914. After graduation he served for
a time as a First Lieutenant in the Medical Corps
in the World War. He was at one time a physi-
cian at the Veterans Hospital at Togus.
After leaving the Service he established an office
in Vassalboro where he has served faithfully and
well that town and surrounding communities for
about twenty-two years.
Doctor Hendee was a member of the Kennebec
County Medical Association, the Maine Medical
Association, the American Medical Association,
and of the Masonic Lodge, The American Legion
and the Episcopal Church.
He is survived by his widow, Charlotte, and his
parents.
George B. O’Connell, M. D.,
1877-1941
George B. O’Connell, M. D., one of Lewiston’s
most prominent citizens, died December 1, 1941, at
St. Mary’s General Hospital, of cerebral hemorr-
hage. He had been in ill health for a number of
months and despite the advice of physicians had
continued his regular work on the St. Mary’s Gen-
eral Hospital Staff, and made regular visits to the
county jail which he had served as physician for
13 years, besides treating his private patients.
Doctor O’Connell was born December 30, 1877,
in Lewiston, the son of John B. and Ann L. Mc-
Carthy O’Connell. He attended local schools in
Auburn, the Edward Little High School, and was
graduated from the University of Vermont Medi-
cal School in 1904. He interned at the Massachu-
setts General Hospital, the A. 0. E. J. Kelly Cliiiic
in Philadelphia, and at St. Mary’s General Hospi-
tal, Lewiston. He began his practice in Lewiston
in 1905.
Doctor O’Connell was a member of the Andros-
coggin County Medical Society, the Maine Medical
Association, and the American Medical Associa-
tion, and of the Knights of Columbus, and St. Pat-
rick’s parish.
Always interested in politics and civic affairs,
he had been urged several times to accept the
office of mayor of Lewiston. He refused this office
but had served as an alderman, and for many
years as city physician. He was a trustee of the
People’s Savings Bank, and a Vice-President of the
First Federal Loan and Savings Bank.
In August, 1916, he married Claire E. Nugent of
Holyoke, Massachusetts, who survives, as do four
children, George B., Jr., senior medical student at
the University of Vermont; Mary Elizabeth, senior
student nurse at St. Mary’s Hospital; Claire L., a
senior at Seton Hill College, Greensburg, Pennsyl-
vania, and Richard, a junior at Lewiston High
School. Also surviving are a sister, Lucy O’Con-
nell Desaulniers, M. D., and a brother, Alfred C.,
both of Lewiston,
40
The Journal of the Maine Medical Association
County News and Notes
100% Paid-Up Membership
for 1942
Piscataquis County Medical Society
A ndroscoggin
Graduate Teaching Clinic at the Central
Maine General Hospital,
Lewiston, Maine
The fourth Teaching Clinic of the twelfth an-
nual series was held on Friday, January 23, 1942.
The program, as follows, was conducted by
Elliott C. Cutler, M. D., Mosley Professor of Sur-
gery, Harvard Medical School; Surgeon-in-Chief,
Peter Bent Brigham Hospital, Boston; Medical
Director of Civilian Defense, Commonwealth of
Massachusetts.
9.30 A. M. to 12.30 P. M. Presentation of Cases.
3.00 to 5.00 P. M. Case Presentations and Ward
Walks.
8.00 P. M. Evening Address: Medicine in Na-
tional Defense: Doctor Cutler.
Cumberland
The 162nd meeting of the Cumberland County
Medical Society was held Friday, January 16, 1942,
at the Eastland Hotel, Portland, Maine. The Presi-
dent, Roland B. Moore, M. D., called the meeting
to order at 7.30 P. M.
The address of the evening was given by Dun-
can Reid, M. D., of Boston, whose subject was
Toxemias of Pregnancy. His paper was discussed
by Drs. Harold B. Everett, and C. Alexander
Laughlin.
Dr. Charles Robie of Boston, was present and
spoke on Pharmacology of Yeratrone Yiricle.
A joint Committee consisting of the Committee
on Public Relations and the Legislative Committee
was appointed to make a study of the requirements
for the training and registration of Nurses and to
report at a later meeting of the County Society.
A Committee consisting of Drs. Owen Smith,
Albion Little, and Earl S. Hall was appointed to
draw up resolutions on the death of Charles B.
Sylvester, M. D.
Ralf Martin, M. D., of Portland was elected to
membership.
The meeting was preceded by a discussion of
Obstetrical Care in the Event of Disaster, con-
ducted by Roland B. Moore, M. D., at the Maine
General Hospital, at 5.00 P. M.
Eugene E. O’Donnell, M. D.,
Secretary.
Penobscot
The monthly meeting of the Penobscot County
Medical Association was held at the Bangor
House, Tuesday, January 20th, with the Presi-
dent, A. W. Fellows, M. D., presiding.
Doctor Hans Weisz of Howland was elected to
membership.
H. L. Robinson, M. D., of Bangor, reported a
meeting of the district group of the Farm Secur-
ity Administration. It was moved, seconded, and
voted that the Penobscot County Medical Asso-
ciation go on record as approving the plans for
medical help proposed by the Farm Security Ad-
ministration, and further moved, seconded, and
voted that a committee of two be appointed to
confer with other district representatives concern-
ing the business details of the plan proposed.
These plans are to be presented at the next meet-
ing of the County Association.
H. L. Robinson, M. D., representing the County
on the Medical Civilian Defense Organization, re-
viewed the general plans for first aid. Allan Craig,
M. D., State Director of Medical Defense, spoke
on the national, sectional, and state set-up.
The scientific portion of the evening consisted
of a paper on: “Prophylactic Sulfonamide Ther-
apy” presented by Champ Lyons, M. D., Associate
in Surgery and Instructor in Bacteriology, Har-
vard Medical School.
There were 64 present.
Forrest B. Ames, M. D.,
Secretary.
York
The annual meeting of the York County Medical
Society was held at the Normandie in Scarboro,
Maine, January 7, 1942.
Officers elected for the year were:
President: Carl E. Richards, Alfred.
Vice-President: Arthur J. Stimpson, Kennebunk,
Secretary-Treasurer: C. W. Kinghorn, Kittery.
Board of Censors: J. R. LaRochelle, 1942; Paul
S. Hill, Jr., 1943; J. H. MacDonald, 1944.
Delegates to the annual session of the Maine
Medical Association: Edward M. Cook, York Har-
bor; Waldron L. Morse, Springvale; and J. H.
MacDonald, Kennebunk.
Alternates: C. E. Richards, Paul S. Hill, Jr.,
and C. W. Kinghorn.
J. L. Pepper, M. D., District Health Ofllcer, gave
a very interesting talk on Infantile Paralysis.
C. W. Kinghorn, M. D.,
Secretary.
41
Nineteen Hundred and Forty-two — February
New Members
Cumberland
Ralf Martin, M. D., 58 Deering Street, Portland,
Maine.
Penobscot
Hans Weisz, M. D., Howland, Maine.
York
Walter D. Mazzacane, M. D., Old Orchard, Maine.
Win Promotions
The following members in active duty have been
promoted from lieutenants to captains:
Herbert T. Clough, Jr. (Penobscot County Soci-
ety member).
Edwin R. Irgens (Kennebec County Society
member ) .
Wedgwood P. Webber (Androscoggin County
Society member).
Notices
Annual Prize in Obstetrics
The American Association of Obstetricians, Gy-
necologists and Abdominal Surgeons announces its
annual “Foundation Prize.” Three copies of all
manuscripts and illustrations entered in a given
year must be in hands of the secretary of the asso-
ciation before June 1. Manuscripts must be lim-
ited to five thousand words and be typewritten in
double spacing on one side of the sheet. Illustra-
tions should be limited to such as are required
for a clear exposition of the thesis. A nom de
plume must he used. The prize will be $150, and
those eligible to compete include internes, residents
or graduate students in obstetrics, gynecology or
abdominal surgery and physicians who are active-
ly practicing or teaching obstetrics, gynecology or
abdominal surgery. Dr. James R. Bloss, 418 Elev-
enth Street, Huntington, W. Va., is secretary of
the association.
Panel Discussions Available to County
Medical Societies
The following Panel Discussions have been made
available for presentation before County Medical
Societies by the Committee on Graduate Educa-
tion:
1. Coronary Disease — E. H. Drake, M. D., Port-
land, Chairman.
2. Complications of Pregnancy — R. B. Moore,
M. D,, Portland, Chairman.
3. Disease of the Liver and Bile Passages —
J. Gottlieb, M. D., Lewiston, Chairman.
4. Endocrine Dysfunction — James Carswell,
M. D., Camden, Chairman.
6. Syphilis — 0. R. Johnson, M. D., Portland,
Chairman.
6. Chemotherapy — F. T. Hill, M. D., Waterville,
Chairman.
7. Appendicitis — I. M. Webber, M. D., Portland,
Chairman.
Application for these panels should be made to
the Chairman one month in advance.
Staff Meetings — Thayer Hospital,
Waterville, Maine
Staff meetings are held every Thursday evening
at 7.30 at the Thayer Hospital, except for the third
Thursdays from September to May inclusive, when
they are omitted because of the meeting of the
Kennebec County Medical Association. The Pro-
fession is cordially invited to attend these meet-
ings. In addition to clinical case studies, special
features are included in certain of the programs,
such as panel discussions, guest speakers, etc.
Tumor Clinics
Bangor: Eastern Maine General Hospital
Thursday, 11.00 A. M.-12.00 M.
Director, Magnus F. Ridlon, M. D.
Lewiston: Central Maine General Hospital
Tuesday, 10.00 A. M.-12.00 M.
Director, E. C. Higgins, M. D.
St. Mary's General Hospital
Wednesday, 4.00 P. M.
Director, R. A. Beliveau, M. D.
Portland: Maine General Hospital
Thursday, 11.00 A. M.-12.00 M.
Director, Mortimer Warren, M. D.
Waterville: Sisters Hospital
1st & 3rd Thursdays, 10.00 A. M.
Director, B. 0. Goodrich, M. D.
Thayer Hospital
2nd & 4th Thursdays, 10.00 A. M.
Director, E. H. Risley, M. D.
WANTED
Wanted — Assistant physician; single
man or woman, or married man without
children; beginning salary $1820. to
$2340. plus maintenance; applicant must
be U. S. citizen. Apply to Carl J. Hedin,
M. D., Superintendent, Bangor State
Hospital, Bangor, Maine.
Have You Paid Your 1942 State and County Dues ?
42
The Journal of the Maine Medical Association
Continued from page 30
3. Wilson, W. C. : Treatment of Burns and
Scalds by Tannic Acid, Brit. M. J., 2:91-94,
1928.
4. Atkins, H. J. B.: Burns, Guy's Hospital
Gazette, 54:320-324, 1940.
5. Harkins, H. N.: Recent Advances in the
Study of Burns, Surgery, 3:430-465, 1938; and
The Treatment of Burns, Springfield, Illinois,
1941, Charles C. Thomas, In Press.
6. Black, D. A. K. : Treatment of Burn Shock
With Plasma and Serum, Brit. M. J., 2:693-
697, 1940.
7. Elkinton, J. R., Wolff, W. A., and Lee, W. E.:
Plasma Transfusion in the Treatment of the
Fluid Shift in Severe Burns, Ann. Surg., 112:
150-157, 1940.
8. Penberthy, G. C., and Weller, C. N. : Treat-
ment of Burns, Am. J. Surg., 46:468-476, 1939.
9. Baur and Boron: Bull, et mem. Soc. nat. de
cliir., 1933, 59:1252.
10. Blalock, A.: Principles of surgical care;
shock and other problems. St. Louis, C. V.
Mosby Co., 1940.
11. Graham, E. A.: Yearbook of general surgery.
Chicago, Yearbook Publishers, 1939.
12. Mason, E. C., Paxton, P., and Shoemaker,
H. A.: Ann. Int. Med., 1936, 9:850.
13. Moon, V. H.: Shock and related capillary
phenomena. New York, Oxford Univ. Press,
1938.
14. Naffziger, H. C. : Surg., Gynec. <& Ohst., 1940,
70:374.
15. Scudder, J.: Shock: blood studies as a guide
to therapy. Philadelphia, J. B. Lippincott
Co., 1940.
16. Wakeley, C. P. G.: Brit. M. J., 1940, 2:679.
17. Wilson, W. C., MacGregor, A. R., and Stewart,
C. P.: Brit. J. Surg., 1938, 25:826.
. . is wholesome
CHEWING GUM
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and good for you. Chewing Gum
doesn’t take the edge off normal
appetites and the healthful chewing
is so satisfying.
What’s more . . . many persons
who enjoy chewing Gum regularly
find it helps keep them on their
toes, yet at the same time helps
relieve excess tension and fatigue.
Try it. Get some today. W-74
You of tho medical profession/ giving so generously of yourselves in these
days of stress, can also enfoy this refreshing sense of a little pick-up from Chewing
Gum. And, as you know, the chewing aids digestion and helps promote mouth hygiene.
NATIONAL ASSOCIATION OF CHEWING GUM MANUFACTURERS
The Journdl
of the
Maine Medical Association
Uolume Thirli^nthree Portland, ntaine, March, 1942 No. 3
The Toxemias of Pregnancy"^
C. Wesley Sewall, M. D., Professor of Obstetrics, Boston University School of Medi-
cine, Boston, Massachusetts.
A brief explanation of these headings
will clarify them;
Hypertensive disease signifies an elevated
blood pressure without apparent associated
pathology except in so far as the vascular
system may be involved. It may be benign
or malignant. All usual factors concerned
in the vascular system are normal except
that peripheral resistance is increased, prob-
ably because of arteriolar spasm, nervous or
chemical in origin, or in more severe cases
there may be definite morphological change
in the wall of the arterioles evidenced by a
thickening of the media of the renal arte-
rioles.
The common finding in hypertensive dis-
ease is an elevation of blood pressure with-
out renal signs such as proteinuria or cell
products. All other findings are relatively
normal. The previous history may reveal no
signs or symptoms of the disease which,
under the stress of pregnancy, become mani-
fest. The malignant form, with its morpho-
logical changes, is markedly aggravated by
pregnancy and is positive proof that preg-
nancy should be interrupted. Usually, in the
malignant type, signs and symptoms are
present before the twenty-fourth week of
* Presented before the Kennebec County Medical Association, September 17, 1941, at Gardiner,
Maine.
In 1937, at the suggestion of Ur. Foster
Kellogg of Boston, the American Com-
mittee on Maternal Welfare appointed a
committee to attempt to secure a uniform
classification of the toxemias of pregnancy.
The result of this committee’s work is the
classification as follows^ :
1. Hypertensive disease
a. Benign or essential, mild or severe
b. Malignant
2. Benal disease
a. Chronic vascular nephritis or nephro-
sclerosis
1). Glomerular nephritis
1 . Acute
2. Chronic
c. Kephrosis
1. Acute
2. Chronic
3. Pre-eclampsia
a. Mild
b. Severe
Eclampsia
a. Convulsive
b. Konconvulsive
4. Vomiting of pregnancy
5. Unclassified toxemias
pregnancy, and this fact is of the greatest "
significance in the final outcome for mother
and child.
Renal disease is not a true toxemia of
pregnancy but a serious complicating factor
of pregnancy. There are three accepted
forms of renal disease: (1) the glomerular
type, rarely seen in the acute stage; (2)
the arteriosclerotic or nephrosclerotic type ;
and (3) the nonhemorrhagic or nephrotic
type. The glomerular type runs an acute
phase, either heals or passes on to a chronic,
edematous type ending in uremia. It may,
and most frequently does, develop into the
nephrosclerotic type. The nephrosclerotic
form is the one most frequently encountered
during pregnancy. Its origin is many times
obscure, or may date back to previous scarlet
fever, other infectious disease, or a preceding
toxemia or eclampsia. It involves the heart
and vascular system, and so cardiac failure,
vasculorenal, or uremic symptoms may result
in the malignant form of the disease. The
degenerative or nephrotic type is character-
ized by excessive edema, albuminuria, but
little if any hypertension, and ends in ure-
mia. It is more frequent than acute glom-
erular nephritis but may be a terminal stage
of both glomerular and nephrosclerotic types,
particularly when it is a wet nephrosis. It is
difficult to evaluate renal disease during
pregnancy, and tlie final diagnosis must
often be made six or more weeks postpartum,
when the persisting renal signs indicate their
kidney origin. It is, however, particularly
important to recognize renal disease as the
causative factor because such disease fre-
quently manifests itself before the twenty-
fourth week or soon after and is tlien the
ultimate factor in determining the prognosis.
Pre-eclampsia mild is most frequent in
the last two months of pregnancy and is the
most common of all the toxemias. It is that
condition in which a moderate rise of the
systolic pressure to about 140 to 160 mm.
of mercury and a diastolic blood pressure
of 90 to 100 mm. of mercury occurs. There
is moderate albuminuria and slight edema,
which may be absent. ISTo retinal changes
are evident. Few progress to eclampsia, but
all should be considered as potentially pos-
sible of doing so. Medical treatment is usu-
? ally sufficient to correct it, but one should
always be imbued with a healthy respect or
even fear of mild eclampsia. Cases so
treated will yield much better results for
both mother and child.
Pre-eclampsia severe becomes evident after
the twenty-fourth week of pregnancy. It is
characterized by a continuous blood pressure
of more than 160 mm. mercury, a diastolic
pressure of more than 110 mm. mercury,
marked proteinuria (0.6 gm. per 100 cc. or
more). Edema is severe, retinal edema is
often present. The symptoms tend to in-
crease in severity in spite of therapy. The
symptoms suggestive of impending eclampsia
frequently appear, such as headache, blur-
ring vision, vomiting, drowsiness or irri-
tability with confusion, or, among the most
reliable warnings, epigastric pains.
Eclampsia of the convulsive type is prob-
ably a transition of severe pre-eclampsia with
convulsions added and the definite morpho-
logical changes in the liver. The renal
changes are also probably the result of the
convulsive seizures because so many times no
residual evidence is later found. Occasion-
ally, convulsions do not occur but coma and
cytological changes are nevertheless present.
Vomitiny of preg^iancy is considered be-
cause of its relation to toxemia, particularly
in its pernicious form. About 50% of preg-
nant women exhibit nausea and vomiting
beginnino- about the sixth week and termi-
nating about six to eight weeks later. It is
amenable to treatment and sliould be re-
lieved, whether by suggestion or therapy. In
the infreciuent cases when it becomes intract-
able, it is named hyperemesis gravidarium
and is a serious disease. The changes in
body metabolism produced by hyperemesis
gravidarium are the accumulative results of
dehydration and starvation with incomplete
oxidation characterized by reduced carbon
dioxide combining power, increased acetone
bodies, uric, amino and lactic acids, and
slightly increased noii-protein-nitrogen. If
such a case is neglected, torpor and coffee-
grounds vomitus appear; oligairia albumi-
nuria, casts, blood make their appearance,
and jaundice with hepatic tenderness are
evident. It may then be too late to cure the
Nineteen Hundred and Forty-two — March
patient by abortion because of profound
tissue damage.
Unclassrified toxemias are those which are
impossible to diagnose during the pregnant
stage because of the confusion of symptoms,
which do not clearly indicate any one or
more of the classifications. Under such head-
ing are conceivable such conditions as drug
poisonings such as chloroform. Weeks after
delivery, when further study is pursued,
most of these cases fall into one or the other
classification. This is particularly true of
the obscure hypertensive and vasculorenal
conditions. It is well to bear in mind that
drugs taken for the relief of chronic pain
may produce toxic states.
Differential Diagnosis
A brief outline of the headings has been
given. The great problem of the clinician is
how to diagnose and classify patients under
these different classes. It is frequently very
difiicult or impossible to diagnose cases
clearly during the immediate and very im-
portant pregnant state. One condition may
blend with another, utterly confusing the
picture, in which case it will not be possible
to correlate the findings until the late puer-
perium. However, whenever possible, it is
very important to be able to recognize defi-
nitely each condition. This is particularly
true in the classification of hypertensives and
renal conditions, especially as they can mani-
fest themselves early or late in pregnancy.
Again one must face the grave responsibility
of passing judgment on whether or not a giv-
en individual should be allowed to go to term
because of severe residual damage or be
allowed a future pregnancy. Severe pre-
eclampsia and eclampsia do not tend to re-
peat themselves conversely some give evi-
dence of permanent renal or hepatic damage.
IMalignant hypertension and severe renal
conditions increase the increment of lasting
tissue damage with each pregTiancy, and fur-
ther pregnancies are therefore contraindi-
cated. With this thought in mind an attempt
is now made to further clarify these condi-
tions by brief differential diagnosis includ-
ing laboratory findings.
Let us first consider hypertensive disease.
In the benign form it is probable that little
45
if any damage will result unless too frequent
and too many pregnancies occur. It is very
essential to follow up these cases carefully
in the late postpartum period for residual
signs, and symptoms. Most of them will ex-
hibit none. During pregnancy both benign
and malignant forms tend to make their ap-
pearance early, as eiddenced by moderate or
severe elevation of the blood pressure. This
hypertension may have been latent but be-
comes accentuated by gestation. Albuminu-
ria is not present, the most important changes
being present in the vascular bed in the form
of arteriolar renal resistance or, in the malig-
nant form, thickening of the media of the
renal arterioles with general arterial degen-
eration. In this form there is often a diffuse
retinitis with edema of the discs. A careful
history may elicit a previous story of disease
or heredity.
The differentiation of renal disease from
pre-eclampsia is important because the for-
mer is as a rule the third most frequent cause
of toxemia and tends to appear early in
pregnancy. It is not so essential to diagnose
the type of renal disease as it is to realize
that renal disease is the causative factor. The
three types have previously been discussed.
A known previous history of nephritic pro-
cess simplifies the diagnosis. So, also, a his-
tory of scarlet fever, frequent sore throats,
or other infectious processes or previous tox-
ic pregnancy. iSTephrosclerosis is the most
common type. Urologists suggest a previous
pyelonephritis of long standing as a causa-
tive factor. The symptoms are commonly
headache, dizziness, visual disturbances ;
edema may or may not be present, the blood
pressure is elevated to moderate or high de-
gree depending on the degnee of renal in-
volvement. Albuminuria is present. There
symptoms as a rule appear earlier in renal
disease than in pre-eclampsia. In the severe
forms they are evident before the twenty-
fourth week and are diagnotic. The urea
clearance is low; renal function by phenol-
phthalein is also lowered. The latter should
be accepted with reservations because of the
fact that dilated, tortuous ureters can act as
a reservoir and retain sufficient urine to up-
set the value of the test.^ However, renal
function is seldom lowered in pre-eel amn si a.
An urea clearance of 50% or less is positive
46
The Journal of the Maine Medical Association
proof of renal insufficiency. Ophthalmo-
scopic examination gives valuable differen-
tial diganosis when it is present. Too many
times in mild renal states it is absent. Ret-
inal hemorrhage and albuminuric retinitis
are present in renal disease, are rare in pre-
eclampsia according to Miller.^ However,
these findings are not always present. A
rise in non protein nitrogen points toward
renal origin. Also many renal patients are
unable to concentrate to 1.021. Cardiac
findings which are abnormal, such as en-
largement, further clinch the diagonsis. It is
the absence of the majority of these findings
that make the diagnosis difficult between kid-
ney and pre-eclamptic states. In such cases,
the diagnosis is not assured until long after
the delivery when the continued high blood
pressure, albuminuria, non protein nitrogen
retention, indicate renal disease rather than
pre-eclampsia. The nonconvulsive form of
eclampsia may be confused with the uremia
of advanced renal disease but in such cases
the above named findings are usually so defi-
nite as to clear the diagnosis easily.
Pre-eclampsia mild is the most frequent
toxemia, occuring in the last two months of
]U'egnancy. It shows a moderate rise in blood
pressure (140-160/90-100), moderate or
ahs'^^nt albuminuria, normal urea clearance,
non protein nitrogen and renal function. The
Mosenthal test is normal. This condition is
the “low reserve kidney,” formerly so desig-
nated by Stander. Postpartum there is a
rapid disappearance of symptoms and a re-
turn to normal.
Revere pre-eclampsia is probably the pre-
cursor of eclampsia. It is differentiated
from mild pre-eclampsia and renal disease by
its sudden accentuation of symptoms. The
blood pressure rises above 160/90 to 200/
110 or more. Albuminuria is marked, a
three plus being common, or ten or more
grams per 100 cc. Uric acid rises to 5 mgs.
or more, non protein nitrogen is normal, oli-
guria is frequent even to approaching anu-
ria ; edema increases, there is rapid increase
in weight indicating water retention, the eye-
grounds show hemorrhages but no albumin-
uric retinitis, occasionally partial retinal de-
tachment. Rometimes these eye findings are
absent yet amaurosis is evident. These cases
suggest a toxic edema of the retina. Revere
headache, lassitude, drowsiness, or epigastric
pain appear to complete the picture.
From this point on is a short step to
eclampsia with its convulsions, coma, oligu-
ria or anuria, marked albuminuria, blood
and casts of all kinds. Detachment of the re-
tina may occur, edema becomes general, blood
pressure is well over 200 mm. with a very
high diastolic reading; non protein nitrogen
becomes high but soon returns to normal with
improvement in the patient. Uric acid is
above 5.5 mg. carbon dioxide combining
power is lowered.
Prognosis
Revere hypertension : pregnancy is contra-
indicated and the uterus should be emptied
as soon as the diagnosis is made. It occur-
rence in the early months of pregnancy helps
in the diagnosis. Mild hypertension should
be viewed with suspicion because of the ten-
dency of pregnancy to increase the damage to
the vascular system.
Renal disease is a grave complication of
pregnancy. Pregnancy shortens the life of
these patients with each succeeding preg-
nancy. The prognosis for the child is only
fair as the multiple infarction of the placenta
as well as the direct effect of the nephritis,
affect its nutrition and development. These
infants often die in utero and are expelled
as macerated, premature fetuses. They are
underweight and appear to lack development
yet it is well known that they survive in a
greater percent than normal infants of simi-
lar weight and size.
Pre-eclampsia is mild. Rest in bed, diet-
ary restriction with low salt is followed by
improvement. If it recurs in subsequent
pregnancies it is usually of the same char-
acter as the first. Reid and TeeU advise cau-
tion in the number of pregnancies allowed.
They believe a certain percent of these cases
show permanent hypertension and possible
residual renal disease.
Pre-eclampsia, severe, may produce perma-
nent tissue damage. It may be a transition
from the mild. If it does not respond to med-
ical treatment promptly, the uterus should be
emptied. One should ever bear in mind the
eclampsia can supervene with very little
warning.
47
Nineteen Hundred and Forty-two — March
Eclampsia always carries a serious prog-
nosis. Tlie maternal mortality varies from
ten to twenty-five percent or more, the fetal
mortality is high, even to forty to fifty per-
cent. Jfeath of the fetus which may occur
during the convulsive stage is frequently fol-
lowed by cessation of tits and recovery. The
number of comuilsions does not necessarily
influence the prognosis although repeated con-
vulsions above ten in number indicate a gTave
outlook. Rapid weak pulse, high tempera-
ture, anuria, jaundice, and inability to sweat
are dangerous signs.
Eden® considers any case which presents
two or more of the following symptoms as
presenting a grave outlook: (1.) prolonged
coma; (2.) pulse rate above 120; (3.) tem-
perature 103 or higher; (4.) blood pressure
above 200 mm.; (5.) more than 10 comuil-
sions; (6) ten or more grams of albumen in
the urine, and (7.) the absence of edema.
Chronic ne])hritis is apt to follow the se-
vere cases a 1 hough in the immediate ])ost-
])artuni period recovery appears to be rapid
with no residual damage. Autopsies on fatal
cases show a thickening of the basal mem-
brane of the glomerular capillaries. The re-
sulting hv])ertension when this glomerular
pathology is present is probably the result of
renal ischemia.'
Treatment
Nausea and vomiting of pregnancy
There are so many remedies advanced for
the treatment of this condition that their
very number defeats them. However, modern
women demand treatment for this most dis-
tressing condition of early pregnancy. Our
routine is as follows : an explanation of this
reflex phenomena with proper encouragement
to reinforce their morale. Thiamin hydro-
chloride, one mg. three times daily, a high
carbohydrate diet, correction of constipation,
adequate fluid intake, frequent small meals.
Formerly no further attempt at treatment
was made beyond this point without hospitali-
zation. Row, if success does not follow this
regime, sodium amytal in one grain doses is
administered as needed, up to 6 grains daily.
Tf rejected by mouth, it is given in solution
by rectum with a one ounce rectal syringe.
Tt is well tolerated by rectum and is equally
efficient.
In the last ten years the author has had
but one instance among his private cases with
this regime that has required hospitalization.
In neglected cases or those in which no oppor-
tunity for treatment has been offered, dehy-
dration and mild inanition become a factor.
These cases should be hospitalized imme-
diately. The same regime plus intravenous
5% glucose in saline is introduced until the
blood chlorides are normal. Thiamin hydro-
chloride may be given these cases with the
glucose in three to five mg. doses. Occasion-
ally a patient presents herself who is deter-
mined to be aborted for various reasons. IJsu-
ally these individuals yield to more vigorous
or semibrutal treatment such as complete iso-
lation from family and friends and the re-
peated use of blunt hypodermic needles or
gastric lavage. Occasionally such a patient,
after repeated admissions to the hospital for
treatment, presents a problem closely resem-
bling true pernicious vomiting characterized
by its extreme dehydration, starvation, and
incomplete oxidation of fatty acids.
Hypereniesis Gravid avium is much more
serious in import. Dehydration and starva-
tion are its early to middle symptoms. Later
there may be hepatic degeneration. Such
cases should be hospitalized immediately and
their tissue fluids promptly replaced by five
percent intravenous glucose in saline with
thiamin hydrochloride. The pelvis should be
explored for pelvic abnormalities, that is
uterine displacement, ovarium heoplasms, etc.
A pessary usually will hold a uterus in place.
The carbon dioxide combining power should
be checked for a sudden fall if vomiting per-
sists. Should the latter continue in spite of
treatment, jaundice, continued loss of body
weight, a somnolent or comatose state, a
rapid, thready pulse up to 120 or more, coffee
grounds-like vomitus appear, the pregnancy
must be terminated. Hepatic tenderness is
an ominous sign. Too often the termination
comes too late for recovery. Glucose should
be given in five percent solution intraven-
ously following delivery to protect the liver.
Hypertensive Disease and Benat Disease
The treatment of both these conditions
should be as one. Mild hvpertensive disease
or renal disease both carry a definite promise
of a certain amount of residual damage. The
48
The Journal of the Maine Medical Association
significance of these conditions should he ex-
plained to the family and then pregnancy
should he allowed only upon full understand-
ing of the risks involved. Close observation,
frequent examination, proper rest are essen-
tial.
Severe hypertensive or renal disease fall
under more or less the same category as re-
gards treatment. Pregnancy should he termi-
nated as soon as serious signs appear, without
attaching too much importance to the life of
the infant. If pregnancy is allowed to pro-
gress until viability of the child, too fre-
quently much permanent renal damage oc-
curs which will definitely shorten the
mother’s life. In addition the fetus may sud-
denly die in utero as a result of the renal
toxemia or it may not have enough develop-
ment to survive. This combination of unfor-
tunate events all too often occurs in well
meant efforts to secure a living child.
A general policy for treatment of all non-
convulsive toxemias is as follows : admit to
hospital all patients who show more than the
slightest possible trace of albumen, a systolic
blood pressure of 150mm. or over, or a dias-
tolic pressure of 100 or more. If the systolic
blood pressure was originally 90 or 100, a
rise to 130 or 140 is just a significant of toxic
disturbance as the higher arbitrary figure.
Complete bed rest. An intake and output
chart is started to measure the -amount of ex-
cretion. If edema is marked, less fluid is
given than the output each day. Diet : Salt-
free, protein sixty grams, fat thirty grams,
carbohydrates four hundred gvams ; this gives
about two thousand calories. The generous
amount of protein is to replace protein loss
and help maintain the blood proteins, par-
ticularly if proteinuria is marked. All preg-
nant patients tend to show some hypopro-
teinemia"^ and this is increased with protein-
uria. Estimation of the serum protein is
therefore a valuable procedure. Dieckmann^
claims hypoproteinemia is not present in
toxemia and that the edema is due to changes
in the permeability of the capillaries and cell
wall. However, pulmonary edema does occur
in serious cases of pre-eclampsia and eclamp-
sia and we believe with Strauss’^ that the
maintenance of proper serum protein levels
is essential to prevent acute edema accidents.
Therefore, when the serum proteins are low
it can be very dangerous to give excessive
amounts of intravenous fluids as they may
precipitate an acute edema. Transfusions of
plasma are to he strongly considered in such
cases to increase the serum proteins. Edema
of the legs or other parts of the body is
abnormal.
Water retention as evidenced by sudden in-
crease in weight over a short period of time
is abnormal hut characteristic of toxemias,
particularly the severe renal, pre-eclamptic
and eclamptic types. If edema is marked and
excessive weight gain is present, the fluids
should he restricted, salt eliminated and mag-
nesium sulphate given by mouth in suflicient
dosage to secure free catharsis. Edema usu-
ally promptly lessens and there is consider-
able weight loss. Hypertensive and renal
cases: complete rest in bed with sedation,
phenobarbital, one-half to one grain three
times a day.
With this policy of treatment many cases
can he carried to term or at least to viability.
The pre-eclamptics often clear up to the point
of a mild albuminuria, hut this is apt to per-
sist until after delivery.
When no improvement or when aggrava-
tion occurs, pregnancy should he terminated.
The following criteria are indications for the
interruption of the pregnancy:
(1) . Increase of blood pressure above
170, or persistence at this point. A high dias-
tolic pressure, that is 120 or more.
(2) . Sudden occurrence of marked
edema.
(3) . Increase of proteinuria to five
grams per twenty-four hours or three plus.
(4) . Hon protein nitrogen fifty mgs. or
more.
(5) . Appearance of cerebral symptoms :
severe headache, visual disturbances, vomit-
ing, and particularly epigastric pain. This
latter is an ominous sign of impending con-
vulsions and must not be disregarded. A
sense of constriction about the lower chest
and waist is also presumptive evidence of
convulsive seizures.
(6) . Pulse rate above 120.
(7) . Oliguria or anuria.
(8) . Appearance of jaundice indicating
periportal vascular pathology.
Nineteen Hundred and Forty-two — March
(9). Cyanosis: if pulmonary edema is
beginning there has been too long a delay or
the serum proteins are too low.
Induction of Labor: Depends on the con-
dition of the cervix. If the latter is soft,
dilatable, and well taken up, simple rupture
of the membranes is suihcient. In other
cases, if the cervix is not too well effaced but
is not too long, a vaginal pack can be inserted
and left eight to twelve hours. In some cases
the pack itself induces labor; in others it
prepares the cervix so that rupture of the
membranes will be successful in starting
labor. In a few cases the insertion of a bag
is necessary. Judgment is required in the
selection of this procedure. The cervix
should be at least partially ready for labor
and not too long. Otherwise labor will be
long and delayed convulsions may ensue and
the fetal risk will be great. If contractions
do not occur within eight hours, one-half to
one minim doses of pitocin may be cautiously
administered every one-half hour until con-
tractions are regular. Pitocin should be so
used with great caution because of its violent
effect on the uterus in sensitive individuals
and its possible tendency to increase oliguria.
Whether to pay much attention to the reduc-
tion in urine is a debatable point which we
think is overbalanced by the urgent need for
delivery. When the cervix is fully dilated
and the presenting part is on the perineum,
an episiotomy with low forceps will decrease
the trauma to the infant and shorten the
labor to maternal advantage. If the breech
presents, extraction is easier on the infant
with a previous episiotomy. Anesthesia
should be local.
In a few selected cases, where a long, hard,
unprepared, primiparous cervix is offered, or
particularly where disproportion is present,
low cervical section may be indicated as the
best method of delivery. Section definitely
increases the maternal risk and does not
necessarily help the infant. Unfortunately
these infants may and do die postnatally
from the profound effects of the maternal
toxemia. Section should therefore be re-
served for those evident cases of evident dis-
proportion, previous obstetrical disaster, or
those uncommon cases where the infant is
either obviously in excellent condition or
49
much desired. Cesarean section definitely in-
creases the mortality in the toxemic state.
Local or spinal anesthesia is the anesthesia
of choice; if not possible, gas oxygen ether
may be used. General anesthesia however,
has a distinct tendency to cause a sudden
oligniria or definite anuria.
Eclampsia
The conservative treatment of this condi-
tion yields better results than bold methods.
The longer convulsions last before delivery
or the greater the number of convulsions, the
greater the mortality for mother and child.
Obstetrical and medical treatment is su-
perior to surgical treatment or premature
meddling. TIany cases go into spontaneous
labor and solve their o’^vn problem. In gen-
eral, the following procedures have given re-
sults, while not satisfactory, are as good in
their outcome as any.
Complete bed rest, constant observation,
the temperature, pulse, and respiration, blood
pressure and urinary output should be re-
corded every two hours. Of course, the
tongue and mouth should be protected with a
suitable mouth gag.
Convulsions : TIorphine sulphate grains
one-quarter subcutaneously often enough
(never less than hourly) to control the con-
vulsions or to slow the respirations down to
fifteen per minute. Magnesium sulphate,
twenty cc. of a ten percent solution intra-
venously, twenty cc. of a ten percent solution
intramuscularly. Uepeat in ten cc. dose of
ten percent solution intramuscularly if fits
continue. A total of not more than fifty to
eighty cc. should be used in twenty-four
hours.
Oxygen is given freely for cyanosis.
An inlying catheter is installed.
Uembutal, guains one and one-half, are
given per os or rectum and repeated as
needed. Barbiturates help to control hyper-
tension. Intravenous glucose, two hundred to
four hundred cc., fifty percent solution, is
given if urinary excretion is diminished ; five
hundred to one thousand cc. of a twenty per-
cent solution of glucose may be given two or
three times daily to promote urinary volume.
Saline should not be used with intravenous
solutions. Caution should be used in the
50
amount of fluid administered because of tlie
danger of producing pulmonary edema.
If the patient is in labor and making prog-
ress allow nature to complete the process. If
labor is slow, rupture of the membranes will
accelerate the contractions. If the patient is
not in labor, we may wait for return to con-
sciousness and diuresis before inducing labor.
On the other hand, if diuresis does not occur,
nothing is lost in rupturing the membranes,
provided no anesthesia is given. After estab-
lishment of diuresis and an improved general
condition, induction may be performed by the
previously described methods. The use of
cesarean section is open to question. If the
patient is anuric and unresponsive, death
will probably ensue, regardless of method or
pelvic disproportion. We have had best re-
sults in reserving cesarean sections when
needed for disproportion and only for this
indication, until the convulsive state is un-
der control, diuresis, consciousness, edema,
blood pressure, and so forth improved. This
we consider the only suitable time when sec-
tion may be performed to advantage of the
patient.
Food is not given per os until the intesti-
nal function is restored and the patient con-
scious. Then fruit juices and water are given
per os.
PnOPHYLAXIS
Frequent prenatal visits are essential to
enable one to recognize toxic states. Careful
histories often will elicit previous cardio-
renal or hypertensive signs. Routine urin-
analyses will And albuminuria. A sudden,
rapid gain in weight, even without edema
should make one suspicious, always ruling
out overeating. Edema and a slight rise in
blood pressure are portentous. It is better
to err on the side of overzealous care ; but it
is absolutely necessary to interpret one’s find-
ing correctly and to treat accordingly. Labo-
ratory findings are of the greatest value when
present, but their absence should not lull one
into a sense of security. Irving^ has written
Three million dollars a month is being
spent on tuberculous soldiers today. Flatly,
it costs around $10,000 to induct a man
suffering from tuberculosis, and $50.00 a
The Journal of the Maine Medical Association
an axiom regarding this which I quote : “the
practitioner who takes an adequate history,
who examines the urine often and carefully
for albumen, blood and casts, and who meas-
ures the blood pressure frequently, requires
no chemical laboratory to make the diagnosis
of albuminuria and hypertension, nor does
he need its aid to tell him whether his pa-
tients are growing sicker or improving.”
It is highly important to differentiate be-
tween the different types of toxemia of preg-
nancy, particularly from the point of prog-
nosis and treatment. Often, however, no
differentiation is possible until the late puer-
perium. These cases should be followed for a
full year postpartum.
Summary
A brief description of the new classifica-
tion of toxemias according to the ideas of the
American Committee on Maternal Welfare
has been given.
An attempt has been made to clarify the
diagnostic signs and symptoms and the dan-
ger points for the clinician.
Modern ideas as applied to treatment of
these conditions are set forth.
Bibliography
1. American Committee on Maternal Welfare,
The Mother, 1:14, 1940.
2. Stander, H. J. Williams. Oh., 8th Edition, 647.
3. Chesley, L. C. Certain Laboratory Findings
and Interpretations in Eclampsia. American
Journal of Obstetrics and Gynecology, ’38:430-
437, 1939.
4. Miller, J. R. The Relation of Albuminuric
Retinitis to the Toxemias of Pregnancy, Am.
Journal Obst., 1915, 72:253-269.
5. Reid, D. E., and Teel, H. M. Nonconvulsive
Pregnancy Toxemias, Am. Journal Obst. and
Gyn., 1939, 37:886-896.
6. Eden, A. Journal Obst. and Gyn., Brit. Emp.,
London, 1922, 29:386-501.
7. Strauss, M. B. Am. Journal Obst. and Gyn.,
38, 199-211, 1939.
8. Dieckman, W. J. American Journal of Sur-
gery, Vol. XLVIII, 101-111, 1940.
9. Irving, P. C. A Study of Consecutive Cases of
Hypertension and Albuminuria in Pregnancy,
Penn. Med. Journal, Feb., 1941.
month for the rest of his life, plus compen-
sation benefits for his dependents after his
death. — D. B. Cragin, M. D., Med. Dir.,
Aetna Life Ins. Co.
Nineteen Hundred and Forty-two — March
51
Acute Intestinal Obstruction: Some Important Points in Its
Diagnosis and T reatment^
By Harey Brinkman, M. 13., Wilton, Maine
The importance of early diagnosis of bowel
obstruction and its immediate and proper
treatment is apparent. With continued ob-
struction and increasing distension the via-
bility of the bowel is threatened, gut perme-
al)ility is altered, the chemistry of the body
is upset, and a fatal outcome is almost cer-
tain to ensue unless the condition is recog-
nized in time and overcome. Such varied
pictures are presented by obstructions in the
bowel as a result of the type and completeness
of the obstruction and its level in the intesti-
nal tract, that the diagnosis is often obscure
if not impossible to make. There are however
certain basic features common to all acute
obstructions which are important and which
must assist one in arriving at a correct diag-
nosis. These have been repeatedly empha-
sized, particularly by Wangensteen.^ These
three basic features are, (1) intestinal colic,
(2) vomiting, and (3) distension.
When there is obstruction to the normal
flow of the intestinal contents, as they are
propelled by peristalsis, tension begins to de-
velop above the point of obstruction, and,
tension in the bowel wall is the adequate
stimulus for pain. Probably no case of acute
obstruction occurs without pain and this pain
is of the type which is commonly called in-
testinal colic ; pain which is synchronous
with the passing of a peristaltic wave through
the portion of the bowel under abnormal ten-
sion. As the wave of contraction approaches
the point of obstruction with its beginning
accumulation of intestinal contents, increased
pressure develops and the contents can escape
only in a reverse direction, if the obstruction
is complete, and as the gas and liquid pass
reversely through the oncoming wave, lx)r-
borygmus develops. This is always present
in the early stages of obstruction and is im-
portant in diagnosis. Unfortunately this
phase has passed in many of the cases when
first seen but a history of this phenomenon
* Presented at the 89th Annual Sessiom.^:t
may often be obtained. If present, it must
then be determined if this colic is due to
obstruction or to some other form of intesti-
nal disturbance such as food indiscretions,
dysentery, etc.
As the intestinal contents accumulate and
are reversed by the persistant peristalsis they
gradually reach the upper levels of the intes-
tinal tract and vomiting occurs, formally
about 7 liters of fluids of various types are
poured into the intestinal tract daily and if
obstruction occurs a point of spilling over
must soon be reached and is usually seen in
cases of small bowel obstruction. Due to the
presence of the ileo-cecal valve, which is com-
petent in many cases, and due to the differ-
ence in the diameter and thickness of the
walls of the small, as compared to the large,
intestine vomiting in cases of colonic obstruc-
tion is not frequently seen. So-called fecal
vomiting is usually indicative of small bowel
obstruction.
Distension above the point of obstruction
of a gi-eat or less degTee is a uniform finding
in obstruction. It may be evident on physical
examination or it may only be demonstrated
by X-ray. Wangensteen and his associates”
have demonstrated that the major portion of
this distension is due to swallowed air, ap-
proximately 68%. The amount of distension
will obviously depend upon the site of the
obstruction and its completeness but disten-
sion is a universal finding either on physical
examination or by X-ray.
The presence of obstruction may often be
easly determined but it is important to know
how the bowel is obstructed. Obstruction
may occur as a result of innumerable condi-
tions but fundamentally there are but two
main types, (1) Simple obstruction of the
bowel lumen, either from within or without,
(2) strangulation with either complete or in-
complete interference with the blood supply
of the involved portion. Clinically, differen-
tain^ Medical Association, York Harbor, Maine,
52
The Journal of the Maine Medical Association
tiation may often be difficult but frequently
physical examination alone may reveal which
type is present. Strangulating obstructions
are usually emergencies, for necrosis of the
involved loop may occur very rapidly, where-
as in simple obstructions conservative meth-
ods of treatment are proper unless the dis-
tension is extreme, particularly those involv-
ing the colon. In simple obstructions there
is usually no tenderness or rigidity of the
abdominal wall while in strangulation ob-
structions there is a sero-sanguinous exudate
which escapes into the peritoneal cavity pro-
ducing hyper-sensitivity. Hot infrequently
localized tenderness may be elicited either on
abdominal palpation or on rectal or vagi-
nal examination. Strangulation obstruction
should be suspected if the onset is sudden
with severe pain, vomiting, signs of peri-
toneal irritation, tenderness and splinting,
leucocytosis, and often associated shock.
External herniae, intussusceptions of in-
fancy and childhood, and obstructions of the
left colon can usually be identified and com-
monly present no great difficulties in diag-
nosis. Obstructions of the small intestine
present the greatest difficulties and often can-
not be localized. Adhesive bands most com-
monly involve the small bowel and are by
far the most common cause next to that of
external herniae. Occasionally acute inflam-
matory lesions with simple obstruction may
simulate that of a strangulating type with
intestinal colic and localized tenderness.
This is a difficult differential diagnosis to
make and an ill advised exploration may eas-
ily change a localizing inflammatory lesion
into a spreading peritonitis.
The phenomenon of visible peristalsis
which is so commonly associated with intes-
tinal obstruction is unfortunately absent in
most acute cases. In these eases the circular
muscle fibers have had no time for hyper-
trophy and visible peristalsis often is not
present. Its presence is of course almost
pathognomonic but its absence should not
mislead one.
Routine laboratory findings give little spe-
cific information in the diagnosis of obstruc-
tion. Serious decrease in the blood chlorides
and increase in the carbon-dioxide combining
power of the blood occurs most commonly in
high obstructions but these findings are not
indicative of obstructions for, they occur in
many other types of lesions which are asso-
ciated with vomiting and electrolyte loss.
The X-ray may however give valuable in-
formation as to the presence, degree, and site
of obstruction. Localization of obstructing
lesions in the colon by X-ray may often be
precise, but in the small intestine it is notori-
ously difficult. One should be very reluctant
to make a diagnosis of intestinal obstruction
on the basis of X-ray findings only. The in-
terpretation of the film should be related to
the clinical picture as obtained from a de-
tailed history of onset, its progress, and physi-
cal examination. Usually two scout films
should be taken, one in the upright position
to determine the presence or absence of gas
in the free peritoneal cavity, and the number
and site of fluid levels. If the patient is too
sick for an upright film one should be taken
in the left recumbent position and a search
made for gas between the right border of the
liver shadow and the lateral abdominal wall.
A second film should be taken with the pa-
tient supine to ascertain the degree of dis-
tension and for localization of the distended
loops. It is well to remember, as pointed out
by Ascroft and Samuels® that false fluid
levels may be seen in the colon and terminal
ileum when an enema has been forced high
and incompletely evacuated. For this reason
they emphasize that films should be taken if
possible before an enema is given.
The number of fluid levels is proportional
to the duration and lowness of the obstruc-
tion. Usually when the obstruction is in the
small bowel there is rarely any colonic
shadow and the cecum contains no more than
a trace of gas. Obstruction can rarely be
accurately localized to any particular seg-
ment of the small bowel except very occa-
sionally with the Miller Abbott type of tube,
but a rough estimate can often be made. If
jejunal loops alone are seen, usually in the
left subphrenic region, the obstruction is
probably high. If ileal loops are seen, usu-
ally in the right side of the pelvis, the ob-
struction is probably low. Localization in the
colon can often be done precisely, particu-
larly if distension is not extreme. If disten-
sion is extreme however, it may be impossible
to demonstrate a mechanical obstruction even
with a barium enema. This should not un-
Nineteen Hundred and Forty-two — March
duly delay one in relieving the obstruction
because of the danger of perforation in the
cecum. Ifepeated X-ray examination may be
necessary and the findings correlated with the
physical findings for they may change appre-
ciably from time to time. This is emphasized
bv Brunn and Levitin'^ who also urge the
closest cooperation between the surgeon and
the roentgenologist.
The recognition that acute intestinal ob-
struction is present is often far easier than
to determine its cause and to make the proper
choice as to treatment. A careful history and
thorough j3hysical examination and meticu-
lous and repeated observations correlated
with the X-ray findings is essential. The
fundamental feature in all acute intestinal
obstructions is the presence of so-called intes-
tinal colic, as Wangensteen has so thoroughly
emphasized. He stated that “bowel obstruc-
tion without intestinal colic does not exist.”
This is present in the early stages particu-
larly whether the obstruction is high in the
small bowel or as low as the rectum. Another
important fact to remember is that the ileo-
cecal valve or sphincter in the majority of
cases allows for only one-way traffic. In a
recent study of the anatomy of this valve,
Wakefield and Friedell estimate that this
valve is competent in about 50% of patients.
However, even if the valve itself is incom-
petent, the more active peristalsis in the
ileum and its greater thickness, and the much
greater diameter of the large bowel which
results in a much greater total stress in the
wall, makes an obstruction of the colon essen-
tially a closed loop. This can easily be demon-
strated by blowing up a rubber glove. Al-
though the rubber in the palm and fingers is
of equal thickness and strength yet because
of the greater surface exposed in the palm
this portion will dilate all out of proportion
to the fingers. This phenomenon in living
tissue is all important for the marked disten-
sion soon compromises the blood supply and
progTessing necrosis may develop and per-
foration occur. The presence of the ileo-cecal
valve therefore and this difference in the
anatomy accounts for the difference in the
clinical pictures in obstructions in the small
and large intestines. Distension, intestinal
colic, nausea and fecal vomiting is indicative
of small bowel obstruction whereas distension
53
and intestinal colic with the persistant ab-
sence of fecal vomiting or colored intestinal
fiuid on gastric aspiration indicates obstruc-
tion of the colon. X-ray examination will
help confirm this by localizing the distended
bowel loops.
Once a diagnosis of bowel obstruction is
made and the cause and site reasonably de-
termined, the question arises as to what to do
about it. Obviously the rational treatment of
any disease or lesion must ultimately be
based upon removal of the cause but it must
also recognize, if possible, the method by
which the cause produces its harmful effects.
The intensive work of Wangensteen here
again offers us the best explanation of the
lethal mechanism. With persistant vomiting
it is clear that the loss of digestive and in-
testinal secretions and electrolytes alone dis-
turbs the chemical balance of the body suffi-
ciently to cause a fatal termination if not
corrected. These ill effects however, can be
obviated by adequate fluids for an indefinite
period provided distension is prevented. If
distension is not overcome, a fatal termina-
tion will soon ensue even though there may
be no demonstrable dehydration or electro-
lyte imbalance. From these observations it
would seem that the distension so impairs the
viability of the bowel wall that it becomes
abnormally permeable to bacteria and prob-
ably other toxic products, the exact nature of
which as yet cannot be adequately demon-
strated. This ap23lies also to str angulation
obstructions with the added factor of blood
loss in the involved loop. He states, “It would
in consequence appear that the rationale of
well-directed therapy should be reduction of
intra-enteric pressure by decompression or re-
lease of the obstructing agent before the via-
bility of the bowel is impaired.”
In general there are two broad methods of
procedure in the treatment of obstructive le-
sions of the bowel, (1) supportive treatment
to overcome the harmful effects of the obstruc-
tion, and (2) decompression or release of the
obstruction. It would seem that the still not
infrequent use of smooth muscle stimulants
and cathartics to increase the force of peri-
stalsis and the use of large and forced enemas
in an effort to overcome the obstruction
should in general be as vigorously condemned
as their use in such lesions as appendicitis.
54
Cases are frequently seen where constricting
bands or twists in the bowel have so devital-
ized the wall that it is conceivable that any
increased pressure from increased peristalsis
or the force of an enema might easily result
in a tear. These lesions like so many others
require nursing not cursing.
Parenteral huids have a definite place in
the vast majority of cases for overcoming the
dehydration and loss of electrolytes incident
to vomiting and for replenishing the supply
of glycogen due to the inability of the patient
to take nourishment.
The work of Coller*^ and his associates in
regard to the fluid requirements of patients
is important in this phase of the problem.
The amount and type to be given to overcome
dehydration, to maintain the blood chloride
level, to substitute that lost by aspiration and
the insensible loss, and to insure an adequate
urinary output can fairly closely be deter-
mined by a rule of thumb after the blood
chlorides have been raised to a normal level.
Fluid aspirated by indwelling duodenal tube
should be replaced volume for volume by
physiological saline. Enough additional 5^
glucose in distilled water to insure a urinary
output of 1000 to 1500 cc. daily will usually
keep the patient in chloride balance and pre-
vent dehydration. This is particularly true
in high obstructions where the electrolyte loss
is greatest.
Blood transfusions have a definite place
for combatting shock, particularly in those
with strangTilations where there may be con-
siderable loss of blood from the intestinal
tract or into the strangiilated loop itself. In
other cases of acute obstructions transfusion
has but a limited indication.
Any other treatment in these cases must
be pointed directly toward the relief of dis-
tension and obstruction either by aspiration
or by operation. The decision as to whether
one should operate immediately or to attempt
decompression by aspiration is one that can-
not be made with any clear cut certainty in
many cases. The time factor in strangulations
and in cases of excessive distensions of the
colon is important. If one undertakes to treat
a case of acute obstruction solely by aspira-
tion for the time being, he must be sure that
no clear cut indication for operation exists,
and must follow the effects of aspiration and
The loumal of the Maine Medical Association
decompression closely by frequent clinical
and X-ray examinations. Successful decom-
pression is evidenced by the decrease in pain,
decrease in distension, visualization of gas in
the colon by X-ray, decrease in the amount
of fluid aspirated, and by tolerance of tem-
porary discontinuance of aspiration without
recurrence of pain. The attempt to avoid sur-
gery is commendable and may often be
successful but valuable time may be lost if
persisted in too long. This is particularly
true in using the long double-lumen tube of
the Miller Abbott type. This is sometimes a
great aid in diagnosis and a valuable means
of decompression if the obstruction is rela-
tively low in the small intestine for it also
affords opportunity for the absorption of
nourishment and fluids above the level of ob-
struction. There are however certain dangers
inherent in its use. The time necessary for
its passage may too long delay dealing with
a strangulation. Its use may also relieve
symptoms without relieving the obstruction
or strangTilation and mislead one into false
security. Obstructions in the colon in general
contraindicates the use of suction as a means
of treatment except that a short period of
aspiration may soon remove gas and fluid
from the upper reaches of the intestinal tract
and improve the patient’s condition for
operation.
In the operative relief of obstructing le-
sions the temptation to do a complete opera-
tion is ever present. One is so often inclined
to do a finished job and find too late that it
is more than the patient will tolerate for
these patients tolerate extensive procedures
poorly. It is therefore good policy to do the
very least that seems necessary. In high ob-
structions of the small bowel, where a tem-
porary fistula may be the greater of two evils,
resection and primary anastomosis may be
the procedure of choice but in the lower
regions this is rarely true.
Enterostomy, either of the valve type or
the production of an external fistula, has
somewhat fallen into disrepute. This is prob-
ably largely due to its ineffectiveness in cases
of ileus. It has further fallen into disrepute
because ileus so frequently follows its use as
a result of contamination — a fault not of the
operation, as such, but of its execution. Al-
though so-called aseptic procedures strictly
55
Nineteen Hundred and Forty-two — March
are not such it probably is true as pointed
out by Steinberg® and others that peritoneal
infection depends upon a cpiantitative as well
as a qualitative factor, particularly in the
presence of obstruction. One naturally liesi-
tates to subject a patient to two operative
procedures but to undertake any extensive
procedure, especially if there is opportunity
for contamination in a patient with obstruc-
tion will increase the risk manifold. Once
the obstruction is overcome the virulence of
the intestinal organism will, have been les-
sened and the peritoneal resistance to infec-
tion enhanced. It is frequently observed that
post-operative peritonitis following secondary
procedures in the presence of an intestinal
fistula, even with gross contamination, is the
exception.
The location of the incision will naturally
depend upon the site of the obstruction and
the nature of the procedure that is contem-
plated. If the operation is in the nature of
an exploratory laparotomy, probably a right
paramedian incision is preferable. If the
obstruction is in the left colon an incision
over the transverse colon is probably a wise
choice so that a transverse colostomy may be
done. This is to be preferred to a cecostomy
for the cecum is usually markedly thinned
out and often cannot be adequately delivered
for proper decompression without contamina-
tion. On opening the abdomen the finding of
bloody fluid suggests the presence of a stran-
gulating lesion which must be found. A valu-
able procedure is to lift the abdominal wall
The Friedman Tuberculosis Remedy has
been rejected after decades of careful investi-
gation by experienced specialists in tubercu-
losis (Munchen. med Wchnsclir., 88:512
April 25, 1941). In the “Friedman law
suit” the worthlessness has been corroborated
on the basis of detailed reports of qualified
experts. The followers of Friedman now use
the old Friedman remedy again under the
new name of “utilin.” The board of direc-
tors and the advisers of the German Tuber-
culosis Society unanimously reject the appli-
cation of “utilin.” — Jour. Amer. Med. Assn.,
July 19, 1941.
with retractors which permits of a wide view
of the abdominal contents, especially if
spinal anesthesia is used. This may obviate
the necessity for an extensive search with
the hand in the aI)doniinal cavity.
Any general presentation of the various
operative procedures which may have to be
employed is obviously beyond the scope of
this paper. The important objective to keep
in mind is to attempt to overcome the ob-
struction by the most conservative means at
hand and to preserve gut viability. The best
choice of procedure at the moment may not
be clear cut and may tax the judgment, in-
genuity, and skill of the most experienced
surgeon. At such times self-control is an at-
tribute that most of us may well seek.
References
1. Wangensteen, O. H.: The Therapeutic Prob-
lem in Bowel Obstruction. Bailliere, Tindall
and Cox, London, W. C. 2.
2. Wangensteen, 0. H., and Rea, Chas. E.: The
Distension Factor in Simple Intestinal Obstruc-
tion. Surgery, Vol. 5, No. 3, pp. 327-339, March,
1939.
3. Ascroft, T. B., and Samuel, E.: A Roentgeno-
logical Study of Intestinal Obstruction. The
Brit. Jour, of Radiology, Vol. XIV, No. 157, pp.
11-22, Jan., 1941.
4. Brunn, Harold, and Levitin, Joseph: A Roent-
genological Study of Intestinal Obstruction.
Surg., Gyn. and Obs., Vol. 70, No. 5, pp. 914-921.
5. Steinberg, B. : Experimental Background and
Clinical Application of B. Coli and Gum Traga-
canth Mixture (Coli Bactragen). Amer. Jour.
Clin. Path.; 6, pp. 253-277, May, 1936.
6. Coller, F. A., Studies in Water Balance, dehy-
dration, and the administration of parenteral
fluids. Minn. Med. 19: 490, 1936.
In a large group of industrial workers,
the proportion of the cases of tuberculosis
found in a minimal stage has almost trebled
since 1929. kloderately advanced cases have
decreased slighting and far advanced cases
are about one-third the former proportion.
This change is explained largely by the fact
that in recent years fluoroscopic examina-
tions of the chest (and roentgenograms when
indicated) have been made prior to employ-
ment and as part of the annual routine exam-
inations of all employees of the ]\Ietropolitan
Life Insurance Company. — From Bulletin
of Met. Life Ins. Co.
56
The Journal of the Maine Medical Association
Things to Know About Accident and Health Insurance"^
By Arthur W. Bade, General Agent Commercial Casualty Insurance Company
Because of the ivvpoy'tance of health and accident insurance in a physician’ s insurance program the
’•Journal'’ has invited Mr. Bade, loho is an expert in the field, to discuss the subject for the benefit of our
members.
Physicians widely aj)preciate the value of
accident and health insurance as a means of
protecting income during periods of disabil-
ity. There are several forms of accident and
health insurance written by many insurors.
These contracts vary in desirability according
to the provisions they contain and sometimes
the exact contents of the policies are not clear
to the insured. In general it may be said that
policies sold for low premiums do not provide
the coverage that may be required and in any
case, the contract should be thoroughly under-
stood to avoid disappointment when a claim
arises. The principal features, both desirable
and undesirable, of common accident and
health insurance policies are analyzed below.
I. The purchaser of insurance should be
sure that the company carrying his insurance
is properly licensed by the State of Connecti-
cut and thereby under the supervision of the
State Insurance Department. In the event of
litigation, the courts of this state have no
jurisdiction over an unlicensed company.
II. The insuring clause of accident in-
surance is the imjDortant part of any contract.
There are variations in the wording of insur-
ing clauses with respect to accident benefits
and the three common ones are discussed in
the order of their desirability.
(a) The most desirable insuring clause
j^rovides for disability resulting from acci-
dental bodily injury. This is the broadest
coverage available because under this clause
the means or the act causing the injury is not
a determining factor in the claim. The re-
suit alone is considered, and many injuries
not covered under other insuring clauses
would be included.
(b) The next most valuable insuring
clause is bodily injury effected solely through
accidental means. Under this clause, strictly
speaking, the injury must result from the
performance of an nnintentional act or the
happening of a purely accidental event and
certain types of injuries would not be covered
under this clause.
(c) The least desirable insuring clause
provides for bodily injury by external and
violent means. This phraseology is the most
restrictive of the three and provides for in-
demnity only when the accident has been
caused by external and violent and accidental
factors.
III. The prospective purchaser of health
and accident insurance should examine care-
fully the provisions of the contract that de-
fine “house-confining” disabilities and “non-
house-confining” disabilities. They apply
with equal force to disability resulting from
accident or sickness. Under the “house-con-
fining” provision the insured must be strictly
and continuously confined indoors to be eli-
gible for full indemnity. For “non-house-
confining” illness causing total disability
some policies pay either a reduced indemnity
or else pay the full benefits for a drastically
reduced period. “Uon-confining” health in-
surance is to be preferred because it provides
the same benefits whether or not the insured
is “house-confined.” The loss of income re-
sulting from total disability is independent
of the confining nature of the disability.
Uon-confining illness should not be confused
with partial disability, they are two separate
things.
IV. There are three ways of limiting the
period for which health and accident con-
tracts may be continued in force.
(a) There are a few strictly “non-can-
cellable” contracts. Under such a policy the
company guarantees to continue the contract
in force upon the payment of the premium
* Printed by permission of the Connecticut State Medical Journal.
Nineteen Hundred and Forty-two — March
when due until the policyholder reaches the
age of 60 or 65. The company agrees in its
contract to continue the coverage regardless
of changes in insurability at a premium guar-
anteed and known in advance. This is guar-
anteed renewable coverage.
(b) Another type of policy which is fre-
quently emphasized to be “non-caiicellahle”
is indeed not so in fact. In this type of con-
tract the company specifically reserves the
right to terminate the contract by refusing, at
its option, to accept any premium. That is to
say, that the contract will not he cancelled
during any policy year, but the company may
refuse to renew the contract for another year
if the risk has proven undesirable.
(c) Most common and least desirable of
all is the type of policy that contains stand-
ard provision Ho. 16. Such a contract may
be cancelled at any time by written notice
sent to the policy holder’s last address.
V. Time limit between date of accident
and commencement of disability is impor-
tant. Policies vary to some extent with re-
spect to this provision. The provisions of
some policies require the disability to be im-
mediate and to commence from the date of
the accident. This is highly restrictive and
unfavorable to the insured because an acci-
dent at the time it occurs might appear to be
of a minor nature but it might create com-
plications, causing disability at a later date.
There are policies which provide that the dis-
ability must commence within a certain num-
ber of days after the accident. The limits
usually range from ten to thirty days. It is
most favorable to the insured when there is
no limit with respect to this provision.
VI. Many contracts provide a reduced
indemnity or an increase of premium when
the insured reaches the age of 55. This
should be understood at the time of the pur-
chasing of the policy.
VII. A common subterfuge in a policy is
to state the monthly indemnity instead of the
weekly indemnity. When the monthly in-
demnity is said to be $200.00 and such a
contract is compared to another contract that
57
pays $50.00 a week a little arithmetic is re-
quired. A policy that pays $200.00 a month
indemnity pays only $46.67 per week.
VIII. The exclusion paragraph sets forth
the limitation of coverage under the policy.
Before purchasing a policy it is advisable to
check the exclusions and make sure that they
are not unreasonably restrictive. Restrictive
exclusions are common in low premium poli-
cies, and the fewer exclusions the better the
coverage. The value of a contract can be
gauged quite accurately by the exclusions list.
Sometimes exclusions are obscured under the
headings of “Additional Provisions” and
“General Provisions.” All policies list some
of the following typical exclusions and some
policies list them all :
(a) Disability from self-inflicted injuries
or attempts at suicide.
(b) Disability from an accident or sick-
ness occurring outside the United States,
Canada and Europe. A travel permit must
be requested from the company when the pol-
icyholder plans a trip outside that territoiy.
(c) Disability resulting from military or
naval service in time of war.
(d) Disability caused by an act of war.
(e) Disability resulting from violation
of law by the policyholder. In policies that
carry this provision the insured might have
no claim if injured, for example, in an auto-
mohile accident while traveling at a rate of
speed in excess of lawful regulations. This is
very restrictive.
(f) Disability resulting from syphilis or
a venereal disease. Restrictive.
(g) Insanity. Restrictive.
(h) Disability caused by tuberculosis,
cancer, or heart trouble commencing during
the first policy year.
Accident and health insurance should be
purchased with care. The best policies con-
tain the desirable features mentioned and can
provide a valuable safeguard for income in
emergency.
58 The Journal of the Maine Medical Association
Editorials
Annual Dues
For several years the Piscataquis County
Medical Society has been first to remit to the
Maine Medical Association its annual dues
100%. 1942 has seen no exception which
reflects jjreat credit to the etficient secre-
tary of that society and the entire member-
ship who appreciate that promptness is a vir-
tue. Members who are not certified by their
county secretary as paid in full on or before
April 1st must be dropped from membership,
exception having been properly made for
those serving in the armed forces of the
United States, and if each member of every
county society would attend to the remittance
of dues promptly it would make easier the
duties of county and state officials. In con-
nection with the importance of maintaining
our own memberships it might be suggested
that any one knowing a physician, not a mem-
ber of his or her county society, constitute
themselves a committee of one to interest that
physician in the ini])ortance of joining the
ranks of organized medicine. It is to the in-
terest of medicine to have every reputable
physician enrolled in its ranks ; it is to the
interest and welfare of every physician to be
enrolled.
In luiity and concord there is strength and
medicine needs strength as never before.
Those who may entertain the fallacious idea
that the enemies of organized medicine and
the present system of medical care in the
United States have given up their fight
against it may be due for a rude awakening.
Under the gniise of national defense, a na-
tional emergency, a deplorable condition of
this, that, or the other thing, or what ever
term they see fit to employ, they will en-
deavor to encroach persistently and purposely
on the methods and means that have enabled
medicine to attain the position it occupies.
That encroachment might obtain as bureau-
cratic control and once control has been
gained or established no little difficulty will
be found to release it.
These are admittedly troublesome and dan-
gerous times. Many new and important re-
sponsibilities confront the profession with
problems that are peculiarly ours, there are
many new functions for it to perform as a
result of the conditions obtaining in and out
of the war. Through its various organiza-
tions, national, state and county, medicine
must be on the alert and properly equipped
in all ways to assume its position in civic
affairs. With the increasing demands to be
made for medical personnel by the armed
forces of the United States there will result
no little disruption of civil and hospital prac-
tice. That disruption must be made as mini-
mal as possible and some of it can and will
be overcome by older men assuming duties
now carried on by the junior members. A
great many men will be obliged to leave their
practices for the duration of the war, which
means no little sacrifice on their part.
Such being the facts, without question, it
is more important than ever that every physi-
cian realize and recognize his responsibility
in the enormous task that lies ahead. It will
be through and by organized medicine that
the burden will be assumed, no matter how
great the demands may be for a sufficient
number of physicians for the armed forces
they must be supplied, yet at the same time
there can be no let-up in furnishing adequate
services for civilian and industrial demands
that must l)y necessity increase in time of
war. The urgency of unanimity, a chin up
attitude to what ever demands are required to
luin, will mean that the job will be finished
as a free and peace-loving people are deter-
mined to have it end ; there is no other way.
The Ninetieth Annual Session
The ninetieth annual session of the Maine
Medical Association will be held at Poland
Springs on June 21st, 22nd and 23rd. It is
not too early to make those days a positive en-
gagement for every possible member of the
association. While not yet ready for publica-
tion in detail it can l)e said that the program
will be one that will appeal to all, no matter
59
Nineteen Hundred and Forty-two — March
their field of practice, and unless something
unforeseen and unlooked for happens the
speaker at the annual dinner will be that
welcome and well-known friend, Dr. Morris
Fishbein, Editor of the Journal of the Amer-
ican Medical Association. Dr. Fishbein is
always an entertaining speaker but this year
his message to our association will be, not
only of interest, but of great importance.
Where is our society strong? Where is it
weak ? As each reads the program prepared
it can be asked; can it be bettered and how
in the meetings to come ? Open suggestions
on this point to the secretary will receive
more than sympathetic consideration. It is
not only the privilege of any member to offer
suggestions but it is his duty if he sees, or
thinks he sees, how the scientific part of our
meetings can be improved.
It will be noted that the clinical confer-
ences offer a diversity of subjects, many of
them . of value to men in general practice,
and while overlapping will result to some ex-
tent, it has been tried to reduce this to the
minimum. The first session of the House of
Delegates will be on Sunday the 21st. To
this, and all subsequent meetings, any mem-
ber is welcome; welcome as a member to
enter into any of the discussions that must
occur in the body that represents the county
societies as a group and which is responsible
for the commitments and assigaiments for the
year to come.
Blood Plasma Banks
The first integrated system of blood plasma
banks for civilian protection in New England com-
munities will be demonstrated by a model net-
work centered in Lewiston, Maine, the Tufts Col-
lege Medical School announced after a meeting
held February 7th at the Central Maine General
Hospital where specialists from its faculty planned
the details with representatives of fourteen hos-
pitals involved.
England’s early preparation of plasma and its
storage in strategic community centers has proved
one of the most vital lifesaving factors among its
air raid precautions, a report of the Lewiston
meeting revealed. The Lewiston network covers
approximately one-third of Maine’s population, in-
cluding the easteinmost industrial and shipbuild-
ing centers of this country.
Communities will receive protection in propor-
tion to the amount of blood they donate, accord-
ing to the plan. Collection depots will be set up
in each of the fourteen community hospitals which
will forward the blood to the Central Maine Gen-
eral Hospital in Lewiston for extraction of the
plasma. Upon its return, the plasma will be stored
in the local hospital for emergency use.
The network of hospitals and regional center
utilizes the identical framework over which Tufts’
postgraduate division at the New England Medi-
cal Center disseminates Boston’s special health
and medical services to distant communities. The
program was inaugurated with the aid of the
Bingham Associates Fund, Bethel, Maine, nearly
a decade ago. Only the technicalities of organizing
the routine of blood collection and processing are
therefore necessary to put the plan into effect. The
next set-up contemplated involves a similar net-
work around Bangor as regional center. The same
methods can be adapted for use in other areas.
It was stressed that some of the communities
in the network were not vulnerable to enemy at-
tack, but blood banks will improve the standards
of community protection against any emergency
and will last indefinitely. The Lewiston plan pro-
vides for retention of about ten percent of the
plasma at the regional center which will be avail-
able for use in any community which suffers a
major disaster. Local hospitals in turn may re-
tain for one or two weeks several units of whole
blood for use in direct transfusions and especially
for immediate protection while first plasma sup-
plies are being processed in Lewiston.
In charge of the program are Drs. Joel Hebert
and Julius Gottlieb, director and pathologist re-
spectively of the Central Maine General Hospital;
and Dr. William Dameshek, assistant professor of
medicine at Tufts and chief of the Blood Clinic at
the New England Medical Center.
The hospitals in the Lewiston network include:
Central Maine General Hospital, Lewiston.
St. Mary’s General Hospital, Lewiston.
Augusta General Hospital.
Bath Memorial Hospital.
Brunswick Hospital.
Camden Community Hospital.
Knox County Hospital, Rockland.
Rumford Community Hospital.
Reddington Memorial Hospital, Skowhegan.
Sisters’ Hospital, Waterville.
Thayer Hospital, Waterville.
Miles Memorial Hospital, Damariscotta.
Franklin County Hospital, Farmington.
St. Andrew’s Hospital, Boothbay Harbor.
60
The Journal of the Maine Medical Association
Necrology
James Francis Cox, M. D.,
1877-1942
James Francis Cox, M. D., for many years a
prominent Bangor physician and surgeon, died
January 18, 1942, following a week’s illness.
Doctor Cox was born in Bangor, July 23, 1877,
the son of James and Mary Geaghan Cox, both of
whom died in his childhood. During his boyhood
he lived in Houlton and attended the schools
there. Following his graduation from Ricker
Classical Institute he entered Georgetown Univer-
sity, Washington, where he completed the fresh-
man year and then transferred to Bowdoin College
as a member of the class of 1904. Upon his gradu-
ation from Bowdoin he entered the Maine Medical
School and received his degree in 1907, and imme-
diately began his interneship at the Eastern Maine
General Hospital. Upon the completion of his
service he entered general practice in Bangor.
His professional skill was early recognized and
he began an extensive practice which continued
up to his last illness. Progressing as a staff mem-
ber of the hospital he finally became one of the
senior surgical staff and was held in high regard
by his associates because of his unusual profes-
sional attainments, his unfailing integrity and his
genial and wholesome personality.
Doctor Cox was a member of Delta Kappa
Epsilon and Alpha Kappa Kappa fraternities at
Bowdoin College, of the Penobscot County Medical
Association of which he was a past president, the
Maine Medical Association, and the American
Medical Association.
In the first World War, Doctor Cox was a Lieu-
tenant in the Medical Corps and served at Camp
Oglethorpe, Chattanooga. Before entering active
service he was a member of the Maine Medical
Reserve and was with the detachment which was
sent to Halifax, N. S., following the harbor explo-
sion, where he had an active part in setting up the
numerous emergency hospitals and giving medical
and surgical relief to victims of the catastrophe.
In early boyhood he gave athletic promise and
at Georgetown and Bowdoin became widely known
as one of the outstanding pitchers in collegiate
baseball. He never lost his enthusiasm for ath-
letics and was an enthusiastic follower of Bowdoin
teams as well as being a devotee of baseball and
football wherever played. Along with athletics.
Doctor Cox was an enthusiastic fisherman and
hunter, and so well did he know the Maine woods
that he qualified as a registered guide.
Doctor Cox leaves his wife whom he married in
1939 and five children. Miss Joan, who was gradu-
ated from the University of Maine and now holds
a secretarial position at the Eastern Corporation;
Miss Barbara, who is attending the Katharine
Gibbs Secretarial School in Boston; James F.,
Jr., a member of the legal .staff of the Merchants
National Bank, Boston; Andrew H., who was
graduated from Harvard Law School in June and
now awaits his call to service; and Evan R., a
student at Maine Central Institute, Pittsfield.
Doctor Cox’s first wife was the former Miss
Mary Burns whom he married in 1913 and whose
death occurred in 1929.
To his patients, in all walks of life. Doctor Cox
was the personification of the kindly physician
and counselor. His many generous deeds were
known only to himself and the recipients, and his
passing will be a heavy sorrow to the wide circle
in which he was so esteemed.
Nineteen Hundred and Forty-two — March
61
County News
100% Paid-Up Membership
for 1942
Piscataquis County Medical Society
Franklin County Medical Society
Cumberland
Portland Medical Club
The annual dinner meeting of the Portland
Medical Club was held at the Lafayette Hotel, De-
cember 2, 1941, at 7.00 P. M. There were 62 mem-
bers and one guest present.
Drs. K. A. Laughlin, Ralf Martin, A. C. Johnson
and Hirsh Sulkowitch were admitted to member-
ship.
The Club adopted Resolutions on the death of
Dr. H. J. Patterson, an honorary member of the
Club.
The annual reports of the Secretary-Treasurer
were read and accepted.
The following officers were elected for 1941-1942:
President: Dr. Francis J. Welch.
Vice-President: Dr. J. C. Oram.
Secretary-Treasurer: Dr. Alice Whittier.
Board of Censors: Dr. H. A. Pingree, Chair-
man; Dr. E. R. Blaisdell and Dr. B. B. Foster.
Committee on Outside Relations: Dr. Donald
H. Daniels, Chairman; Dr. R. S. Hawkes and Dr.
J. M. Parker.
Liaison Committee: Dr. Thomas A. Foster,
Chairman; Dr. E. E. O’Donnell and Dr. F. A.
Ferguson.
Dr. M. C. Webber, retiring President, spoke
briefly of the changes in medicine since he joined
the Club thirty years ago.
Dr. F. J. Welch was the Orator and he chose for
his subject, “Anecdotes.” Dr. Welch entertained
the members with recollections of unusual experi-
ences in the years before, during, and after his
medical school days.
Respectfully submitted,
Alice A. S. Whittier,
Secretary.
The regular monthly meeting was held at the
Columbia Hotel, January 6, 1942, at 8.15 P. M.
There was a record attendance of 70 members and
three guests.
Dr. W. A. Monkhouse was elected to member-
ship.
Dr. George A. Tibbetts spoke on “Local De-
fense,” explaining the set-up of a report center and
the sub-divisions notified in case of an air raid.
Dr. Carl M. Robinson reported on “General Med-
ical Defense,” explaining the arrangements made
for care of the wounded in case of a disaster.
Dr. Roland Moore spoke briefly concerning
“County Defense.”
and Notes
A motion picture on “Vitamin B-Complex” was
presented by representatives of E. R. Squibb and
Sons.
Following the meeting light refreshments were
enjoyed.
Respectfully submitted,
Alice A. S. Whittier,
Secretary.
Kennebec
A meeting of the Kennebec County Medical As-
sociation was held at the Elmwood Hotel, Water-
ville, Maine, Thursday, February 19, 1942.
The Clinical Program at 5 P. M., which follows
was presided over by L. Armand Guite, M. D.,
President;
1. Cholecystitis, Stomatitis, Proctitis — A. H.
McQuillan, M. D.
2. Extensive Laceration of the Abdomen — N.
Bisson, M. D.
3. Acute Leukemia — 0. F. Pomerleau, M. D.
4. Common Duct Stone — E. H. Risley, M. D.
5. Severe Injury of Thigh with Complications
— L. Armand Guite, M. D.
6. Nasopharyngeal Fibroma with Pneumocepha-
lus— F. T. Hill, M. D.
Dinner at 6.30 P. M. was followed by a business
meeting.
Minutes of the last meeting were read and ap-
proved.
Celia Hirschberger, M. D., of Waterville, Maine,
was elected to membership.
Henry W. Abbott, M. D., of Waterville, Maine,
was reinstated to membership.
The application of T. Dennie Pratt, M. D., of
Waterville, Maine, was received and referred to
the Council.
C. R. McLaughlin, M. D., of Gardiner, Maine, di-
rector for Kennebec County of the medical section
of the Civilian Defense program, outlined the steps
that have been taken thus far to meet the demands
of any emergency that might occur.
The speaker of the evening was Alan R. Moritz,
M. D., Professor of Legal Medicine, Harvard Medi-
cal School; Lecturer in Legal Medicine, Tufts Col-
lege Medical School, and Boston Lniversity School
of Medicine; Consulting Pathologist, Massachu-
setts State Department of Public Safety; Consult-
ing Pathologist Massachusetts State Department
of Mental Health, etc., who spoke on sudden
deaths. Dr. Moritz stressed the importance of med-
ico-legal investigation in unexpected deaths. Such
deaths should be subject to meuico-iegai investiga-
tion, he said, in oraer that homicide would not go
undetected, to protect innocent persons, in order
that evidence pertaining to the auministration of
civil justice might be determined and in order that
hazards to the life and weii-oeing of the general
public should not escape official notice. Illustrat-
ing his talk with slides. Dr. Moritz pointed out
several circumstances wnere homiciue was likeiy
to be overlooked without an autopsy.
Among those attending were George L. Pratt,
M. D., of Farmington, past-president of the Maine
Medical Association; County Attorney William
62
Niehoff of Kennebec County, and Attorney Ben-
jamin Butler of Franklin County.
There were 35 members and guests present.
Respectfully submitted,
Frederick R. Carter, M. D.,
Secretary.
Thayer Hospital —Wat erville, Maine
The following cases were presented at the Staff
Meeting held Thursday, February 5, 1942, at 7.30
P. M.
1. Pyelitis — Dr. W. L. Gousse.
2. Influenzal Pneumonia — Dr. J. O. Piper.
3. Cholecystitis and Cholelithiasis — Dr. N. Bis-
son.
4. (a) Cholecystitis with Secondary Stomatitis
and Proctitis; (b) Gastric Ulcer — Dr. A. H. Mc-
Quillan.
5. (a) Carcinoma of Recto-sigmoid (Death) ;
(b) Carcinoma of Breast — Dr. E. H. Risley.
6. Traumatic Cataract — Dr. H. F. Hill.
7. (a) Chronic Pansinusitis; (b) Cyst of Man-
dible—Dr. F. T. Hill.
8. Critique on Chemotherapy — Opened by Drs.
E. H. Risley, J. O. Piper and Arnold Moore.
The Journal of the Maine Medical Association
Piscataquis
A meeting of the Piscataquis County Medical
Association was held at Dr. R. H. Marsh’s resi-
dence at Guilford, Maine, on Friday, February 20,
1942.
Guy E. Dore, M. D., reported for the committee
which has been active in attempting to suggest a
fee schedule for the County.
Harvey C. Bundy, M. D., reported on the Farm
Security Administration Plan. It was voted that
the Piscataquis County Medical Association join
this plan for one year. Doctors Bundy and M. O.
Brown were elected a committee to review and
audit doctors’ bills for Piscataquis County.
78% of our members were present.
N. H. Nickerson, M. D.,
Secretary.
New Members
Kennebec
Henry W. Abbott, M. D., Waterville, Maine.
Celia Hirschberger, M. D., Waterville, Maine.
Coming Meetings
National Medical Societies
American Medical Association
Olin West, M. D., 535 North Dearborn
Street, Chicago, Secretary.
Annual Meeting— Atlantic City, June 8-12,
1942.
State Medical Societies
Connecticut State Medical Society
Creighton Barker, M. D., 258 Church
Street, New Haven, Secretary.
Annual Meeting — Middletown, June 3-4, 1942.
Maine Medical Association
Frederick R. Carter, M. D., 142 High
Street, Portland, Secretary.
Annual Meeting — Poland Spring, June 21-23,
1942.
Massachusetts Medical Society
Michael A. Tighe, M. D., 8 The Fenway,
Boston, Secretary.
Annual Meeting — Boston, May 26-27, 1942.
New Hampshire Medical Society
C. R. Metcalf, M. D., 5 South State Street,
Concord, Secretary.
Annual Meeting — Manchester, May 12-13, 1942.
Rhode Island Medical Society
W. P. Buffum, M. D., 122 Waterman Street,
Providence, Secretary.
Annual Meeting — Providence, June 3-4, 1942.
Vermont State Medical Society
Benjamin F. Cook, M. D., 154 Bellevue
Avenue, Rutland, Secretary.
Annual Meeting — Bennington, October, 1942.
Convention Rates
1942 A nnual Session
Poland Spring House, Poland Spring, Me.
June 21, 22, 23, 1942
The following room rates, which include all
meals, will prevail:
Single rooms without bath $6.00 per day
Double rooms without bath, per per-
son $6.00 per day
Double room and single room with
connecting bath, for 3 persons,
per person .' $7.00 per day
Two double rooms with connecting
bath for 4 persons, per person ....$7.00 per day
Double room with bath for 2 persons,
per person $7.00 per day
Single room with bath, per person $8.00 per day
The charge for non-registered guests for meals
will be as follows:
Breakfast
$1.50
Luncheon
$2.00
Dinner
$2.50
Golf green fees will be $1.00 per day. The tennis
courts and Beach Club will be available without
charge.
The Hotel Orchestra will be available four hours
each day for dancing.
Poland Spring Water, both Natural and Carbo-
nated, loill be served at all times to the guests of
the hotel.
For reservations write the Poland Spring House,
Poland Spring, Maine.
Make Your Reservations Early
Nineteen Hundred and Forty-two — March
63
Notices
Bureau of Health
Services for Crippled Children
Clinic Schedule
Bangor: Eastern Maine General Hospital
Thursday, 1.00 P. M.-3.00 P. M.:
April 2, May 7, Tune 4, July 2,
August 6, September 3, October
1, November 5, December 3.
Waterville: Thayer Hospital
Thursday, 1.30 P. M.-3.00 P. M.:
April 30, June 25, August 27, Oc-
tober 29, December 31.
Rockland: Knox Cotinty Hospital
Thursday, 1.30 P. M.-3.C0 P. M.:
May 21, August 20, November 19.
Portland: Children's Hospital
Monday, 9.00 A. M.-ll.OO A. M.:
April 13, May 11, June 8, July
13, August 10, September 14, Oc:
tober 12, November 9, December
14.
Fort Kent: Normal School
Monday, 9.00 A. M.-ll.OO A. M.,
sometimes from 1.00 P. M-.3.00
P. M. also. May 4, June 29, Au-
gust 24, October 5, December 7.
American College of Surgeons
War Sessions
The American College of Surgeons is contem-
plating a series of one day meetings, with a pro-
gram for each meeting that will concentrate on
medicine and surgery in military service and in
civilian defense. Every state in the Union and the
District of Columbia will be included in the plan,
either singly or in combination.
Maine, New Hampshire and Vermont will meet
on Wednesday, April 1st, at the Eastland Hotel in
Portland, from 9.00 A. M. to 9.00 P. M. The meet-
ing will be open to the entire medical profession
from the states included in the area. All details
of the program will be arranged in the central
office of the College in Chicago; Irvin Abell, M. D.,
Chairman, Board of Regents, 40 East Erie Street.
The members of the Maine State Executive
Committee are:
Chairman: Eugene B. Sanger, M. D., Bangor.
Secretary: Carl M. Robinson, M. D., Portland.
Counselors: Frank H. Jackson, M. D., Houlton;
Edward H. Risley, M. D., Waterville.
American Academy of Pediatrics
The American Academy of Pediatrics, Region I,
will meet at the Bellevue Stratford Hotel in Phil-
adelphia, Pa., April 1, 2 and 3, 1942.
Registration Committee,
Db. Carl C. Fischer,
Germantown Professional Bldg.,
Germantown, Philadelphia, Pa.
Presque Isle: Northern Maine Sanatorium
Tuesday, 9.00 A. M.-ll.OO A. M., 1.00
P. M.-3.00 P. M.: May 5, June 30,
August 25, October 6, Decem-
ber 8.
Lewiston: CenU'al Maine General Hospital
Saturday, 9.00 A. M.-ll.OO A. M.:
March 28, April 25, May 23, June
27, July 25, August 29, September
26, October 24, November 21, De-
cember 19.
Rumford: Rumford Community Hospital
Wednesday, 1.30 P. M.-3.00 P. M.:
April 22, June 17, August 19, Oc-
tober 21, December 23.
Machias: Normal School
Wednesday, 1.00 P. M.-3.00 P. M.:
April 15, July 15, October 14, Jan-
uary 20.
Portland Children's Hospital
Cardiac: Tuesday, 9.00 A. M.-ll.OO A. M. :
April 14, May 12, June 9, July
14, August 11, September 8, Octo-
ber 13, November 10, December 8.
Lewiston St. Mary's Hospital
Cardiac: Friday, 1.30 P. M.-3.00 P. M. : March
27, April 24, May 22, June 26,
July 24, August 28, September
25, October 23, November 20, De-
cember 18.
N. B. This clinic schedule is subject to change.
If changes are necessary adequate notice will be
given.
Please destroy previous schedule.
The American Congress on Obstetrics
and Gynecology
The Second American Congress on Obstetrics
and Gynecology will be held in St. Louis, April 6-
10, 1942.
Fred L. Adair, M. D.,
General Chairman,
650 Rush Street,
Chicago, Illinois.
The American College of Physicians
Announces Its Twenty-sixth Annual
Session to Be Held in St. Paul,
Minn., April 20-24, 1942
Dr. Roger I. Lee, of Boston, is President of the
College, and will be in charge of the program of
General Sessions and Lectures. Dr. John A. Lepak,
of St. Paul, has been appointed General Chairman,
and will be in charge of the program of Hospital
Clinics and Round Table Discussions, as well as
local arrangements, entertainment, etc. Mr. Ed-
ward R. Loveland, Executive Secretary of the Col-
lege, 4200 Pine Street, Philadelphia, will have
charge of the general management of the session
and the technical exhibits.
WANTED
Wanted — Assistant physician; single
man or woman, or married man without
children; beginning salary $1820. to
$2340. plus maintenance; applicant must
be U. S. citizen. Apply to Carl J. Hedin,
M. D., Superintendent, Bangor State
Hospital, Bangor, Maine.
64
The Journal of the Maine Medical Association
Book Reviews
“New and Non-Official Remedies, 1941”
Containing Descriptions of the Articles which
stand accepted by the Council on Pharmacy
and Chemistry of the American Medical As-
sociation on January 1, 1941.
Published by the American Medical Association,
Chicago, 1941.
In this book are listed and described the articles
that stand accepted by the Council on Pharmacy
and Chemistry of the American Medical Associa-
tion on January 1, 1941. Articles having similar
composition or action are grouped together as in
previous publications. Some articles have been
omitted, others added, and in some revised state-
ments on composition, standard of purity, identity,
strength, action, etc., are presented on many items,
“Annual Reprint of the Reports of the
Council on Pharmacy and Chemistry
of the American Medical
Association for 1940”
With the Comments that have appeared in the
“Journal.”
Published by the American Medical Association,
Chicago, 1941.
This small volume contains reports of the
Council adopted and authorized for publication
during 1940. Its pul)lication was authorized by
the Council in order to make these reports avail-
able to physicians, chemists, pharmacologists and
others who are interested in medicine.
“Synopsis of Applied Pathological
Chemistry”
By: Jerome E. Andes, M. S., Ph. D., M. D., F. A.
C. P., Director of Department of Health and
Medical Advisor, University of Arizona, Tuc-
son; Formerly Assistant Professor of Path-
ology and Clinical Pathology, West Virginia
University Medical School; and A. G. Eaton,
B. S., M. A., Ph. D., Assistant Professor of
Physiology, Louisiana State University
School of Medicine, New Orleans.
With 23 Illustrations.
Published by The C. V. Mosby Company, St.
Louis, 1941. Price, $4.00.
The primary purpose in writing this latest mem-
ber of the synoptic set is to provide a practical,
simple, easily read text on the application of
pathological chemistry to clinical medicine. The
subject matter has been condensed as much as
possible in order to eliminate any unnecessary
reading. Unproved speculations are not indulged
in. In order to help in fixing facts in the reader’s
mind, more important material is usually sum-
marized in the form of tables. The information
here given is hoped to be acceptable to the bio-
chemist, physiologist, pathologist, surgeon, clini-
cian, and to the medical student and interne.
Pause at the familiar red cooler for ice-cold Coca-Cola. Its life, sparkle
and delicious taste will give you the real meaning of refreshment.
The Journal
of the
Maine Medical Association
Uolume Thirlt^ '-three Portland, Hlaine, April, 1942
No. 4
Medical and Psychiatric Problems of Selective Service"^
By Lieut. -Col. Donald E. Cueeiee, Medical Corps, U. S. A.; Chief, Medical Division,
Selective Service, l\fassachusetts
During World War I some 5,000,000 men
were physically examined by local draft
board physicians and by the army doctors at
the reception centers. Judged by any previ-
ous standard, the examination they received
was relatively good, but we learned from
costly experience that it was not good enough.
I don’t have the exact figTires but up to the
time this is being written only about 1,200,-
000 men have been similarly examined. How-
ever, it is correct to say that never in the
nation’s history have so many men been so
carefully examined as during the past eleven
months. Twenty-five years ago 29.1% of the
draftees were rejected for physical reasons —
whereas now something over 59% or almost
exactly twice as many are being turned down.
The rocking chair brigade fastened onto these
facts — which, of course, were well-publicized
in the press — and began wringing their hands
and moaning about the deplorable deteriora-
tion of the nation’s health in the past twenty-
five years. Of course this is rubbish ! There
has not been any deterioration at all. Quite
the contrary. The real answer is that our
standards were too low then, and there has
been a fairly audible whisper here and there
suggesting that they are too high now. Per-
sonally, I don’t think so. I don’t think so
for a number of reasons.
First of all, as this opus profundum is be-
ing written, the United States is officially at
peace, whereas in 1917 we were at war. In
those hectic days we were trying to raise a
very large aniiy as quickly as possible. To-
day, as you know, the size of the army is
limited and it is comparatively small. Hot
only that, but it is an entirely different kind
of an army. Quality of man power has be-
come vastly important. Everything is mech-
anised today and vehicles have to be kept in
motion if they are to be of any use. Instru-
ments of precision such as range finders,
directional sound detectors, etc., were known
to us after a fashion during the war, but they
were not very complicated and, if I may be
permitted to use the vernacular, they were
very scarce. How everything has some kind
of a gadget attached to it that would take a
Swiss watchmaker to assemble and a really
intelligent soldier to use. Furthermore, every
arm of the service must be coordinated 100%
during an attack — all their movements must
be synchronized to a split second, if the thing
is to go. This presupposes a complicated and
efficient system of communications. Until
* Read before New England Psychiatric Society, October 17, 1941.
66
Mr. Hitler’s misadventure in Russia, we all
know that he didn’t use more than 10% of
his available armed forces to subdue Poland,
France, Belgium, Holland, and all the rest —
and he probably used less. But what was in
action was the last word in efficiency — and,
you may he sure, intelligent from the mean-
est private to the brass hats who ran the
show. Hothing ever brought home to mili-
tary men so dramatically the fact that there
is less and less room in the modern army for
the man with a strong back and a weak mind
as did the blitzkrieg through the low coun-
tries and France. The moron was fine and
dandy when there was a mule to bury or a
latrine to dig. But, of course, there are no
longer any mules to bury and it is my honest
conviction that an intelligent soldier will dig
a better latrine than a nit-wit. Incidentally,
I can tell you from personal experience that
the best latrine ever dug is a pathetic com-
promise— especially in the rain.
Hor has it taken the War Department all
these years to discover that the army was no
place for the C. P. I.’s, the neurotics, the in-
troverts, and all the rest of the inhabitants
of that pallid outer fringe of mental health.
They began to look at this unhappy clan with
a fishy and a jaundiced eye when they real-
ized that fully fifty millions of the taxpayers’
money was being spent every year for com-
pensation, hospitalization and so on, for the
mental cases alone resulting from the World
War. That means more than a billion dollars
up to January 1, 1941. Long, long ago, when
the world was young, a billion dollars was a
lot of money. You can even find some incor-
rigible conservatives here and there who still
think so. Therefore, they are very anxious
to screen out the mentally unfit. Certainly
those of us who had any first-hand experience
with the problem during the war feel the
same way about it.
I happen to have been an artillery officer
assigned to the 76th Division. Our regiment
received some draftees from the outlying dis-
tricts of Maine and Yew Hampshire — the
cities and larger towns all had their quotas
already in the Yational Guard. I remember
one tiny Yew Hampshire village had a draft
quota of one man. Whether what happened
was just the normal functioning of the fish
The Journal of the Maine Medical Association
bowl, or whether the town fathers found it
easy to defer some of the more useful citi-
zens, I wouldn’t know. But, in any event,
we drew the town fool. It took us four long
months to wind up the red tape necessary
to get him a discharge for disability. If he
gave the town fathers half as much trouble
as he gave us, I can understand only too well
how Luther happened to pass his physical ex-
amination. Although this man was the only
complete economic and military zero we had,
I recall a good many who were pretty small
fractions and were nothing but a colossal nui-
sance from their induction to their discharge.
One of these mental giants insisted on cover-
ing the front of his uniform with celluloid
buttons advertising politicians, Moxie, cigar-
ettes, and God knows what. Confinement to
quarters, confiscation of the buttons — ^noth-
ing did any good. When I left the outfit
seven months later he was still appearing in
ranks dressed in celluloid buttons. You can’t
make me believe that someone didn’t know
that he was absolutely useless as army mate-
rial.
Yow for just a moment let us return to
this question of whether or not the national
health has been going in reverse since the
AVorld AVar. Being physicians, of course you
know that it couldn’t have — ^you know that
the various departments of public health and
our epidemiologists have done a wonderful
job in reducing the incidence of various con-
tagious diseases. You know that our serolo-
gists have made possible astounding strides
in the field of immunization. And now our
chemo-therapists have come along with that
incredible driio’ sulfanilimide and all its de-
o
rivatives. This momentous discovery dwarfs
Banting’s insulin and Ehrlich’s magic bullet.
One disease after another has succumbed en-
tirely or, in large part, to the power of this
amazing drug — scarlet fever, rheumatic
fever, peritonitis, pneumonia, meningitis,
erysipelas, gas gangrene and gonorrhea, to
mention just a few— and the end is not yet.
You know what bacterial endocarditis, re-
sulting from scarlet, K. L. and rheumatic
fever, means in terms of our national health
as well as I do, but I wonder how many of
you could give me even an approximate idea
of what has been happening in this field.
Nineteen Hundred and Forty-two — April
67
The figures that I am about to give you are
Massachusetts figures, but they don’t differ
essentially from those of Maine or New
Hampshire or almost anywhere in the United
States.
When I graduated from college in 1914, I
thought we had just about reached the mil-
lenium in Massachusetts as far as sanitation
and preventive medicine went, and yet in
that enlightened year 652 people died of
diphtheria, a rate of 17.9 per hundred thou-
sand of population. In 1940 there were eight
deaths from diphtheria, or a rate of .2%.
Inoculation against typhoid isn’t nearly as
common and universal a practice as the inoc-
ulation with toxin-antitoxin for diphtheria
but if you stop and think about it you will
realize that a lot of people get it sooner or
later. During the World War upwards of
5.000. 000 men in the army were protected
against typhoid and, while that immunity is
supposed to last only from three to four
years, we know perfectly well that it is at
least relatively effective throughout life.
Since 1922 in Massachusetts we have had an
average of 10,000 men in the National Guard
with an average annual turnover of about
3.000. At that rate, up to January 1, 1941,
there have been 67,000 men protected against
typhoid in this group alone. To this number
must be added whatever of our citizens are
in the regular army, navy, marine corps, and
coast guard. Roughly 2,000 young women
enter nurses’ training schools every year in
Massachusetts and, while inoculation is not
compulsoiw, it is, invariably done. Also there
are maii}^ other persons who for one reason or
another take the typhoid shots. At any rate,
due to all these things plus our greatly im-
proved sanitation and methods of prepara-
tion and handling of food, this is what has
happened. During the Spanish War the
death rate from typhoid was 25 per liundred
thousand. If the same percentage had exist-
ed in 1940, 1,075 people would have died in
Massachusetts. Actually eight died.
In 1895 scarlet fever with its terrible
sequel! of mastoids, Bright’s disease and
damaged hearts was a monstrous destroyer
of children. If the death rate of 40 per hun-
dred thousand which prevailed then should
be translated into terms of our present popu-
lation of 4,300,000, it would mean that 1600
j)eople would die of scarlet fever every year
— and most of those would be children. As a
matter of fact, in 1940 there was just under
one death per hundred thousand of popula-
tion. I don’t know what you think about
that, but I think that it is a thrilling and
soul-stirring achievement. Also, I think the
foregoing is a very effective answer to the
rocking chair brigade. Every time you im-
munize one individual against typhoid you
reduce by that much the danger of an epi-
demic, and evei’3^ time you prevent diph-
theria or scarlet in a child vou reduce bv
*j fj
that much the chance of valvular heart
disease.
On the other side of the ledger, however,
are some things which make us realize that
all is not sweetness and light. There is too
much “hidden hunger” and poverty in the
richest nation on earth and there are too
many deficiency diseases in this land of
plenty. As you well know, there are too
many rejections among our selectees, even
taking into consideration the high standards
under which we are operating. I have al-
ready said that 59% of our young men are
not acceptable to Uncle Sam. At the local
board physical examinations 52% are re-
jected and 48% passed. Of those passed an
additional 15% are rejected at the induction
centers — and 15% of 48% is 7.2% of the
whole number. It does not follow that all
these rejectees are physical wrecks because
they are not. A gTeat many of them are
carrying on successfully in civil life and
doubtless will continue to do so. It must be
remembered that these men are not being
picked for one year of training, or even
thirty months ; they are being chosen with
the understanding that, after their period of
training is over, they will become part of a
reserve military pool and available for the
armed forces for the ensuing ten years. But
any way you look at it, it is a depressing re-
flection that so many of our young men in
the prime of life cannot pass what, after all,
is a perfectly reasonable physical examina-
tion.
It is true that the British wouldn’t have
any army at all if they attempted to enforce
dental requirements the equivalent of ours —
68
but we only require twelve teeth, three pairs
of opposing incisors and three pairs of op-
posing masticating teeth, ISTot only that, but
they don’t all have to be natural teeth — dum-
mies are acceptable and so is bridgework if
the character of the workmanship warrants
it. Keasonably good occlusion, however, is
insisted upon. Army rations have to be not
only bitten but chewed. Sometimes that takes
quite a lot of doing. It would seem, wouldn’t
it, that almost any man between twenty-one
and thirty-five could scare up twelve teeth
that met. But, as A1 Smith would say, “Let’s
examine the record.” Almost 17% of our
registrants are thrown down by our local
board physicians for insufficient teeth and
10% of those who pass their initial examina-
tion are rejected by the induction center phy-
sicians for dental reasons. That is one reason
that I say there is too mnch poverty in these
United States. Personally I don’t think
these standards are too high and, yet, if we
should suddenly have to raise a large army
in a hurry, this is the first one which would
be lowered.
To continue briefly with the causes and
percentages of rejections, 9.7% failed be-
cause of defective vision or eye pathology,
6.5% had a musculo-skeletal defect of one
kind or another, 4% had diseases of the
heart or blood vessels, 5.04% were either
mentally defective, epileptics or psychoneu-
rotics. These figures were faken from a re-
cent breakdown of 2,030 examinations at
local boards in Massachusetts. They were
spot-checked from fifty-four cities and towns
scattered throughoTit the state so that they
would give us a good cross-section. Of that
number 1,117, or 55%, were rejected and
913, or 45%, were accepted. Some of the
registrants were turned down for more than
one reason so that we had a total of 1,314
causes. These figures, it seems to me, carry
their own implication. I might say in pass-
ing that I made no attempt to break down
the psychoneurotic cases because the diagno-
ses were made by general practitioners and
I was a little dubious about their accuracy,
Meedless to say, there are rejections for all
sorts of other things — hernias, varicose veins,
diabetes, tuberculosis, obesity, malnutrition,
etc., almost ad infinitum, but the percentages
The Journal of the Maine Medical Association
in these other groups is small and I won’t
bore you with the fignires.
Mow, let us see what happens to the men
who pass this first examination when they get
to the induction center. Here again there are
rejections for everything under the sun al-
most, but I will mention only the more com-
mon causes. You may be surprised to know
that neuropsychiatric rejections led the field
with 17.8% and that figure does not include
the mental defectives who account for an
additional 6.6%. In the order of importance
come eyes with 12.2%, cardiovascular dis-
eases with 9.5%, lungs 9.0%, teeth 8.5%,
ears 6.8%, and so on down the list. Epilepsy
accounted for 2.7%.
For statistical purposes and for clarity all
psychoneurotic cases are divided into eight
groups, as follows :
I. Mental Defect and Deficiency.
II. Psychopathic Personality.
III. Major Abnormalities of Mood.
lY. Psychoneurotic Disorders.
Y. Schizoid and Related Personalities.
VI. Chronic Inebriety, specifying alcohol-
ism or drug addiction under Re-
marks.
VII. Syphilis of the Central Mervous Sys-
tem.
VIII. Other Organic Diseases of Brain,
Spinal Cord, or Peripheral Merves,
specifying the full neurological di-
agnosis under Remarks.
When a local board physician is in doubt
as to the mental status of a registrant he
may, and obviously should, refer the case to
the Medical Advisory Board. There are fif-
teen such boards in Massachusetts and every
board has at least one top-flight psychiatrist
on its roster whose duty it is to examine the
man to determine the nature and extent of
his mental illness and occasionally to detect
malingering. One is tempted to go off on a
tangent and discuss malingering as there are
some interesting yarns to tell about this re-
sourceful and wily brotherhood. What
amazes ns all is that there has been so little
of it. The medical officers’ bible is a war
department pamphlet entitled, “Mobilization
Regulations 1-9.” There are set forth our
Nineteen Hundred and Forty-two — April
69
physical standards, and, there, also, is a short
treatise on how to spot the malingerer, call-
ing attention to some of the more subtle and
clever methods employed. In fact, some per-
fectly swell suggestions are offered to the
potential faker if the publication should fall
into his hands. The distribution of the
pamphlet is quite general and it is about as
hard to obtain as, let us say, the Old Farmers’
Almanac.
But to get back to our medical advisory
board psychiatric goings-on. As I write this
I have before me reports of 87 referred cases
examined by such men as Dr. Macfie Camp-
bell of Boston, Dr. Bonner of Danvers, Dr.
Ball of Northampton State, and so on. Of
the 87 cases 16.01% were in gTOiip I, 14:.9%
in group II, 2.3% in gTOup III, 49.4% in
gToup IV, 9.1% in group V, 3.5% in gTOup
VI, none in gTOup VII because they are too
young for that, and 11% in gvoup VIII.
These figures are interesting simply because
they give the relative frequency of the vari-
ous types of mental disease.
In attempting to discuss the neuropsychi-
atric problem as it affects the army in par-
ticular and the national defense in general, I
am fully aware of my shortcomings. I am no
psychiatrist, and I make no pretention to any
real knowledge of the subject, although I
think it is fair to say that I have been ex-
posed to more psychiatry than the average
general practitioner. I can speak to you,
though, as one who has served in the armed
forces not only as a medical ofiicer but as a
line officer as well. I have come to grips
many times with the problem of the soldier
who is mentally unfit and who never should
have been put in a uniform. I have been in-
terested in seeing the mesh of the neuropsy-
chiatric screen made fine and I want to see
it kept that way. I have been not a little
impressed with what our psychiatrists have
been able to accomplish with the limited time
available for each examination. And I as-
sure you that I do not share the conviction
held by some army officers I know that the
average psychiatrist is a good deal of a nut
himself.
There are several angles to all this but the
one which immediately concerns us is the
army angle. The question is how can the
misfits be kept out when the average time for
the neuropsychiatric examination cannot
much exceed six minutes. Can we get more
psychiatrists, can the examination be made
more efficient, can some program be put in
motion for instructing the local board exam-
iners in psychiatry so that fewer such regis-
trants will reach the induction centers — in
short, is there any substitute for time ? Of
course the obviously mentally sick don’t take
very long, but they are not the group that
gives the army the real headache. Their
chances of getting by the present set-up are
very slim. Even if such an individual should
and subsequently develops an attack of manic-
depressive insanity, he can be handled with
promptness and dispatch. No, it’s the border-
line group that gives us the blues. Let me
give you an example of the type I mean and
the situation he creates. Registrant John
Doe of East Pitch, Massachusetts, goes all
over town telling the world that nobodv is
going to stick him in the army at thirty bucks
per — not on your life — that’s all right for the
suckers — but for him ? The hell with that —
and all and sundry are urged to watch him
beat this racket. His swagger gTows with
every passing day. Well, the reaction of the
local board is a perfectly natural one, they
want more than anything in the world to see
this gent in the airniy and, if possible, on per-
manent K. P. The local doc who has known
John for a nasty brat almost since the day he
brought him into the world feels the same
way about it. Needless to say, John is physi-
cally 0. K. and after he has turned heaven
and earth to have his 1-A classification set
aside without success, he is whisked off to the
induction center — and very likely a letter
may have gone along on the Q. T. setting
forth some of the facts. Enter the psychia-
trist. Letter or no letter, if he has time
enough he gets John’s number all right and
can imagine quite well what has gone on.
By the bye — here is a nice decision for him
to make — shall he pass John for the whole-
some effect it will have on the other boys of
draft age or shall he reject him because he
knows he will be an all-American pest in the
army ? But suppose the psychiatrist has been
rushed all day and is a little behind his con-
freres, a bottleneck has developed in his de-
70
partment and lie is trying to catch up. John
gets by. Practically everybody in East Pitch
is tickled pink but onr hero’s commanding
officer won’t be. Selectee Doe will find his
level in the army and he will join a small
coterie that exists in almost every military
organization, and they always run true to
form. They hate the army and everything
connected with it ; they resent and resist
military discipline; they get ngly when they
are assigned to guard duty or K. P. ; it isn’t
their turn and they are forever being picked
on ; they are insubordinate in small things
and sometimes in large ones ; they get drunk
whenever the opportunity presents itself and
are habitually late to formations ; they eat
everything in sight but complain eternally
about the food; they are sullen and anti-
everything and raise the devil generally with
the morale of the outfit. In short, they are
the absolute bane of the organization com-
mander’s existence. I know that if every
captain commanding an infantry company
or an artillery battery could speak to you, all
would say the same thing and all would
ask you to do what you could to keep such
people at home. You all know that, if some-
one had had time enough to dig into the his-
tory of these men, there would have been
abundant evidence to show that they suffered
from the same malady in civilian life.
Where, then, shall we draw the line ? One
can’t reject every registrant just because he
doesn’t want to go into the army, even if he
wants pretty badly to stay at home. There
are too many men like that. If a natural re-
luctance to be separated from family and
friends and to lose one’s freedom temporarily
were adequate cause for rejection, we might
just as well abolish selective service and go
back to our old policy of volunteer recruit-
ing. We have tried that in almost every war
the United States has been involved in and it
has always been a dismal failure.
May I digress for a few moments and tell
you a few facts about our experience with
volunteer recruiting in the past — facts I am
sure you never read in your history books at
school. I don’t need to remind you that the
Pevolutionary War dragged on its weary
course for seven long years. Yet any student
of military tactics could tell you that, if
The Journal of the Maine Medical Association
Washington had had 10,000 seasoned troops
at his disposal, the war would have been over
in six months. He never had anvAino- like
O
that number, although during the seven years
he had a total of nearly 400,000 men. Even
though the British never had more than
42,000 men in this country at any one time.
General Washington was always pathetically
outnumbered. In 1777 he had one thousand
regulars and two thousand militia, whose en-
listment was due to expire within a month,
to face twenty thousand British in and
around ISTew York. Every time his volun-
teers had had enough training to be of some
value to him, their enlistments would expire
and he would have to start all over again.
Imagine trying to fight a war under such a
handicap. That he was able to do it success-
fully is a great tribute to his military genius.
It was the same old story for the same old
reason during the War of 1812. We em-
ployed, all told, 527,000 troops between 1812
and 1815, whereas the maximum number of
men the British ever had in the field at any
one time was 16,500.
General Santa Anna might easily have
beaten Winfield Scott if his army had been
anything but a rabble because when Scott
was about in the middle of his advance to
IMexico City he had to stop and send home
four thousand men, or more than 40% of his
entire command, because their enlistments
had run out.
Yobody ever told me when I was a boy in
school that Union troops in the Manassas
area actually marched away to the sound of
Confederate cannon because of the termina-
tion of their enlistments. I’ll bet those ba-
bies were right on hand for the plaudits of
the multitude to say nothing of a free meal
and a noggin of grog on every Decoration
Day, just the same. It is sad but true that
you cannot raise an army of any considerable
size by voluntary enlistment. Yo nation ever
has. Conscription was the reason for the suc-
cess of Caesar’s legions and compulsory mili-
tary service is the only answer and always
will be. Did you know that Moses and Aaron
classified the Jews and placed 603,000 of
them in Class I ? If you don’t believe me,
look it up when you get home in the first
chapter of Yumbers.
71
Nineteen Hundred and Forty-two — April
I seem to have gotten pretty far away from
the subject I came here to discuss so I will
get back to it if I can find my way. When I
got off the track I was talking about the
really difficult neuropsychiatric cases to de-
cide on. The physical examination at the in-
duction centers is patterned after the produc-
tion line and each man has to produce about
so much to avoid a bottleneck. Very shortly
only regular army, reserve and federalized
national guard medical officers can be used
for these examinations, and the number of
psychiatrists is definitely limited. How,
then, can we perform the terribly important
function of keeping out of the army the men
who won’t make good soldiers ? The only
help I see for the induction board psychia-
trists is to give the local board physicians
enough instruction so that they can screen
out a lot of these borderline cases at the
source. You are the onlj'- ones who can do
that. The question is, id ill you ? I think I
know the answer to that.
I have been on this podium altogether too
long now, but I have one more favor to ask
of you before I stop. As you, of course, real-
ize, many of our rejectees could be complete-
ly rehabilitated — for instance by having the
necessary dental work done or a hernia re-
paired. Many more could be markedly im-
proved if proper remedial measures were
taken. All over the country there will be a
comprehensive plan for making rehabilita-
tion facilities available to these men in the
near future. In some states plans are already
well under way. While no one can say this
as a fact, it looks very much as though some
federal funds would be forthcoming to de-
fray actual costs — but, as usual, the doctors
are expected to contribute their services. Ho
one can force a rejected registrant to take
advantage of these opportunities — it must be
entirely voluntary. If we are careful to
make clear that this is an attempt to make
healthier and happier citizens and not a trick
to get more men in the army, I think a great
many men will avail themselves of these fa-
cilities. We are all a little shocked to learn
how many are in need of psychotherapy, but
we feel that a substantial number would
gladly accept treatment for their difficulty if
they could get it. You are the only men who
can give it. The question is, will you? I
think I know the answer to that, too.
Gall bladder disease, although infrequent
in the young, should be included in a differ-
ential diagnosis of abdominal lesions in
children. It is probable that many cases go
undiscovered, a clinical diagnosis not having
been made because it is such a rare condi-
tion in childhood.
Cholecystographic studies should be made
more frequently in children, and surgical
exploration of the biliary tract is not done
often enough during the removal of a so-
called interval appendix.
A case of non-calciilous gangrenous chol-
ecystis in a four-year-old child is reported by
L. Byron Ashley, M. D., and A. S. Harotzky,
M. D., of Detroit in The Journal of the
Michigan State Medical Society for April,
1911. The patient complained of abdominal
pain and vomiting for three days before
admission to the hospital. General tender-
ness of the entire abdomen, especially on the
right side, was elicited, but no mass was
palpated. Temperature 100.4. Pulse 144.
Respirations 20. Leukocytes 7400, with 62
polys. Urinalysis negative. Diagaiosis of
acute surgical abdomen was made, and the
finding of an acute appendix was expected.
At operation, a tense gangrenous gall blad-
der was found, with free peritoneal fluid
and exudate around the gall bladder. Ho
stones were found. The gall bladder was
drained, a section removed for biopsy, and
the contents cultured. The pathologist con-
firmed the diagTLOsis, and the cultures pro-
duced no gTowth.
The patient made an uneventful recovery
and has since remained in good health.
Where the standard of living is low, tu-
berculosis is high. In no way is poverty more
tragic in its relation to disease than in tu-
berculosis.— Charles R. Retholds, M. D.,
Bull. Nafl Tuber. Assn., Aug., 1940.
72
The Journal of the Maine Medical Association
An Attempt to Ascertain the Clinical Value of the Rate of Blood
Sedimentation; Based on a Study of Five Hundred
Unselected Patients^
By E. R. Blaisdell, M. D., E. A. C. P., and K. E. Smith, M. D., Portland, Maine
The recognition of the increased sedimen-
tation rate in illness is not new ; indeed,
Hippocrates noted in doing venesections that
separation of the red and light portions of
the blood was more rapid in many illnesses
than in healthy patients. However, it was
not until 1917 that the first scientific investi-
gation of this phenomenon was made.
Fahraeus^ at this time observed an increased
sedimentation of the red cells in pregnancy,
but recognized that this was not specific for
any particular disorder. During the past
twenty-four years more than two thousand
articles and books dealing with both the scien-
tific and clinical aspects have been published
on the subject.
The largest clinical series of which we are
familiar was reported by Cutler" who, in
1932, had studied five thousand patients dur-
ing a six-year period. In his summary he
states, ^‘As a diagnostic aid, an increased rate
indicates disease ; as a prognostic index, and
similarly as a guide in treatment, the rate of
sedimentation has been shown to be a more
accurate and reliable reflection of the real
condition of the patient than our usually
accepted procedure.”
Obviously, with so many investigators in
this field, several different methods of per-
forming this simple procedure have been de-
vised. It is our belief that all of the popu-
lar methods are sufficiently accurate to be
practical. We do feel, however, that a tube
at least 200 mm. in length is important, as
shorter tubes tend to favor packing which
will slow up the rate especially in those
bloods where the rate of sedimentation is
rapid. Some writers have proposed studying
the rate over a twenty-four hour period ; this
seems tedious, and for practical purposes a
rate estimated at the end of sixty minutes
appears sufficient.
Clinically, it may be remembered that ac-
celeration of the blood sedimentation rate is
associated with those processes which are
accompanied by inflammation or necrosis, or
by an increase in the fibrogen content of the
blood plasma. However, a superficial inflam-
matory process with good drainage need
cause no acceleration at all, while the same
degree of inflammation in an area without
drainage will accelerate the rate. Infectious
diseases without marked local inflammation
rarely show any great increase in the rate of
sedimentation.
We have studied 500 unselected patients
in this series, 150 of whom were office pa-
tients seen by one of us (E. B. B.) and the
remainder were service patients on the wards
of the Maine General Hospital. The regular
Westergren tube was used with a 3.8% solu-
tion of sodium citrate as an anticoagulant.
0.2 cc. of the anticoagulant was combined
with each 0.8 cc. of blood, and readings were
taken at the end of sixty minutes.
Of the 150 office patients, 51 had rates
above normal. The highest rates occurred in
pneumokoniosis (1 patient j, in carcinoma (2
patients), in acute rheumatoid arthritis (16
patients), in pleurisy with effusion (1 pa-
tient), in active pulmonary tuberculosis (4
patients) and in acute chorea (1 patient).
This increased rate in acute chorea is prob-
ably an exception rather than the rule, and
most authorities do not list chorea as a cause
of increased blood sedimentation. This was
an interesting patient, however; the rate of
blood sedimentation remained high for 6
weeks and fell slowly as the symptoms im-
proved. In the remainder of the 150 patients
studied, it will be noted that the exudative
processes were absent, or only slight, and like-
wise there was little change in the rate.
* Read at the Annual Meeting, Maine Medical Association, York Harbor, Maine. June 24. 1941.
Nineteen Hundred and Forty-two — April
73
Blood Sedimentation Bates in 150
TJnselected Office Patients
No. of Average
Disease Patients Sed. Rate
Neurasthenia
18
normal
Chronic Constipation
2
normal
Gastric Neurosis
1
normal
Irritable Colon
15
normal
Appendicitis (subacute)
2
normal
Duodenal Ulcer (uncomplicated)
2
normal
Cholecystitis (subacute)
5
2 X normal
Cholecystitis (chronic)
2
normal
Cholelithiasis (chronic)
4
normal
Tapeworm
1
11/^ X normal
Allergic Migraine
1
normal
Allergic Enterocolitis
1
normal
Contact Dermititis
1
normal
Eczema
2
normal
Asthma
1
normal
Hysteria
2
normal
No Complaint (routine exam.)
1
normal
Myositis
1
normal
Thyrotoxicosis
1
normal
Avitaminosis
2
normal
Diabetes (uncomplicated)
1
normal
Hypochromic Anemia
1
normal
Chronic Prostatitis
1
normal
Influenza (mild)
1
114 X normal
Pleurisy with Effusion (probably
T.B.)
1
5 X normal
Pulmonary T. B. (active)
4
314 X normal
Pneumokoniosis (T. B. not found)
1
314 X normal
Pulmonary T.B. (healed)
1
normal
Bronchitis (acute)
4
2 X normal
Bronchopneumonia
1
3 X normal
Bronchogenic Carcinoma
2
31^ X normal
Metastatic Carcinoma of Spine
1
5 X normal
Acute Tracheitis (mild)
2
normal
Acute Tonsillitis (convalescing)
1
normal
Labyrinthitis
1
normal
Acute Chorea
1
4% X normal
Salpingitis (subacute)
1
1^4 X normal
Acute Neuroretinitis
1
normal
Iritis
1
114 X normal
Keratitis (physical exam, neg.)
1
normal
Osteoarthritis with Acute Retinitis
1
2 X normal
Rheumatoid Arthritis (subacute)
6
2 X normal
Rheumatoid Arthritis (active) 16
3% X normal
Rheumatoid Arthritis (inactive)
3
normal
Pseudo-arthritis (allergic)
1
normal
Pseudo-arthritis (menopausal)
6
normal
Osteoarthritis
6
normal
Arthritis (unclassified)
1
3 X normal
Acute Bursitis
1
2 X normal
Chronic Bursitis
1
normal
Angioneurotic Edema
2
normal
Sciatica
1
normal
Chronic Rheumatic Heart Disease
1
normal
Angina Pectoris
1
normal
Carotid Sinus Irritability
1
normal
Cerebral Hemorrhage
1
2 X normal
Berger’s Disease (active)
1
214 X normal
Vascular Occlusion in Leg (em-
bolic) 1
Phlebitis of Leg (subacute) 1
Chronic Arteriosclerotic Vascular
Occlusion of Leg 1
Chronic Phlebitis of Leg 1
Essential Hypertension 1
Chronic Nephritis 1
Acute Pyelitis 1
normal
normal
normal
normal
normal
normal
2% X normal
The Blood Sedimentation Kate in 350
TJnselected Hospital Patients
TABLE 1
Acute, Subacute, and Chronic Pyrogenic
Infections
a. 48 patients with acute infections had an av-
erage rate of 3 X normal.
b. 10 patients with subacute infections had an
average rate of 2 X normal.
c. 4 patients with chronic infections had an av-
erage rate of 114 X normal.
TABLE 2
Tumors
Benign;
a. 16 patients before operation had an average
rate of normal.
b. 21 patients after operation had an average
rate of 2 X normal.
Malignant:
a. 18 patients before operation had an average
rate of 2 X normal.
b. 3 patients after operation had an average
rate of 2 X normal.
c. 8 patients before radium had an average rate
of 114 X normal.
d. 2 patients after radium had an average rate
of 114 X normal.
e. 9 patients who were classified as inoperable
had an average rate of 3 X normal.
TABLE 3
Pregnancy
a. 6 patients in the first three months of preg-
nancy had an average rate of normal.
b. 6 patients in the last six months of preg-
nancy had an average rate of 3 X normal.
c. 22 patients in the first week postpartum had
an average rate of 3 X normal.
d. 11 patients in the second week postpartum
had an average rate of 2 X normal.
74
The Journal of the Maine Medical Association
TABLE 4.
Fractures
Patient Age
Sex
Location
Complications or Operations
Rate
Temp.
1.
65
M
Tibia
normal
99
2.
60
F
Neck of Femur
rales base right lung
5 X normal
99.5
3.
46
M
Base of Skull
bloody spinal fluid
2 X normal
100
4.
74
F
Neck of Femur
10 days after nailing
2% X normal
98
5.
52
F
Ankle
compound
1% X normal
98
6.
31
M
Ribs
pneumothorax and hydrothorax
3 X normal
99.6
7.
37
M
Pelvis
4 X normal
99
8.
68
M
Humerus
1% X normal
98
9.
28
M
Malar Bones
comminuted with blood in antrum
11/^ X normal
99.4
10.
57
F
Pelvis
3 X normal
98
11.
59
M
Wrist
normal
99
12.
27
M
Wrist
normal
98
13.
55
F
Humerus
2 X normal
98
14.
56
M
Fingers
lacerations on hand
2 X normal
98
15.
53
F
Leg
normal
98
16.
50
M
Ankle
compound
normal
98
17.
28
F
Both Ankles
normal
98
18.
33
F
Leg
4 X normal
98
19.
44
F
Ankle
2 X normal
98
20.
52
M
Tibia and Fibula
comminuted
5 X normal
101
21.
50
M
Ankle
3 X normal
99
22.
76
M
Ankle
pneumonia (resolving)
5 X normal
99
23.
53
F
Thigh
non-union in old fracture
normal
98
24.
64
F
Femur
decubitus ulcer
5 X normal
100
25.
53
F
Leg and Arm
2 X normal
98.6
26.
30
M
Spine
old fracture
normal
98
27.
79
F
Hip
2 X normal
98
28.
60
M
Spine
compression fracture
11/4 X normal
98
29.
24
M
Ankle
Summary:
4 days after wiring
29 patients had an average rate of 2 X normal.
3 X normal
98.6
TABLE 5
Major Surgical Lesions
(Classified as “clean cases” at time of operations)
Patient Age
Sex
Type
Remarks
Rate
Temp.
1.
57
Procidentia (complete)
1 day following operation
2 X normal
99.5
2.
20
M
Inguinal Hernia
before operation
normal
98
3.
69
M
Inguinal Hernia (stran-
gulated)
1 day after operation
normal
99
4.
27
M
Inguinal Hernia
3 days after operation
normal
98
5.
42
M
Inguinal Hernia
1 day after operation
normal
98
6.
19
M
Inguinal Hernia
before operation (mild bronchitis)
2 X normal
98
7.
18
F
Bilateral Hallux Valgus
10 days after operation
normal
98
8.
51
F
Cholecystectomy for gall
stones
8 days after operation
before operation
2 X normal
98
9.
28
M
Inguinal Hernia
normal
98
10.
83
M
Inguinal Hernia (stran-
gulated)
6 days after operation (stitch abscess)
4 X normal
100
11.
27
M
Inguinal Hernia
before operation
normal
98
12.
19
M
Inguinal Hernia
before operation
normal
98
13.
40
F
Umbilical Hernia
before operation
normal
98
14.
68
F
Cataract
10 days after operation
2 X normal
98
15.
28
M
Inguinal Hernia
8 days after operation
2 X normal
98
16.
53
F
Perineal Repair
10 days after operation
3 X normal
99
Summary; 6 patients before operation bad an average rate of normal.
10 patients after operation had an average rate of 2 X normal.
Nineteen Hundred and Forty-two — April
75
TABLE 6
Neevous and Mental Diseases
Case
Age
Sex
Diagnosis
Rate
Temp.
1.
27
F
Multiple Sclerosis
normal
98
2.
30
F
Acute Psychosis
normal
98
3.
26
M
Gastric Neurosis
normal
98.6
4.
30
M
Menier’s Disease
normal
98
5.
58
M
Dementia Precox
normal
98
6.
43
F
Neurasthenia
normal
98
7.
36
F
Gastric Neurosis
normal
98.6
8.
21
M
Neurasthenia
normal
98
9.
34
M
Gastric Neurosis
normal
98
10.
66
M
Multiple Sclerosis
normal
98
11.
46
M
Multiple Sclerosis
normal
98.6
12.
51
F
Psychoneurosis
normal
98
13.
54
M
Psychoneurosis
normal
100
14.
46
M
Neurasthenia
normal
98
15.
34
M
Neurasthenia
normal
98
16.
16
M
Fredericks Ataxia
normal
98
17.
33
F
Menopausal Neurosis
normal
99
18.
75
M
Atonic Colon
normal
98
19.
38
F
Psychoneurosis
Summary; All 19 patients studied had individually a
normal
normal rate.
98
TABLE 7
Pneumonia
Case
Age
Sex
Type
Remarks
Rate
Temp.
1.
70
F
Bronchopneumonia
5 X normal
101
2.
72
M
Bronchopneumonia
5 X normal
100
3.
72
M
Bronchopneumonia
3 X normal
104
4.
36
M
Lobar Pneumonia
4 X normal
105
5.
69
F
Bronchopneumonia
1 day before discharge
2 X normal
98
6.
28
M
Bronchopneumonia
1 day before discharge
1% X normal
98
7.
47
F
Bronchopneumonia
5 X normal
101
8.
23
M
Lobar Pneumonia
aborted
1 X normal
98
9.
61
F
Bronchopneumonia
convalescing
3 X normal
98
Summary: 9
patients had an average rate of 3 X normal.
TABLE 8
Sprains and Skin Lacerations
Case
Age
Sex
Type Complications
Rate
Temp.
1.
24
F
Sacro-iliac Sprain
normal
98
2.
62
M
Lacerations of Hand
normal
98
3.
45
M
Lacerations of Hand
normal
98.6
4.
41
M
Sacro-iliac Sprain
normal
98
5.
49
M
Laceration of Scalp
normal
98
6.
26
M
Laceration of Ankle Slight Cellulitis
normal
99
7.
19
M
Laceration of Hand
normal
98
8.
46
F
Laceration of Hand
normal
98
9.
28
F
Laceration of Hand
normal
98
10.
22
M
Laceration of Hand
normal
<)8
11.
69
M
Laceration of Head
normal
98
12.
45
M
Laceration of Head
normal
98
13.
19
M
Sacro-iliac Sprain
normal
98
14.
27
M
Laceration of Chest
normal
98
15.
19
F
Laceration of Finger
Summary: 15 patients had an individual rate of normal.
normal
98
76
The Journal of the Maine Medical Association
TABLE 9
Kidney,
Bladder, and Uretteral Stones
Case
Age
Sex
Location
Complications
Rate
Temp.
1.
16
F
Kidney
normal
98
2.
56
M
Bladder
3 X normal
98
3.
36
F
Kidney
normal
98
4.
69
M
Kidney
(bilateral)
4 X normal
98
5.
78
M
Bladder
normal
98
6.
59
M
Kidney
2 X normal
98
7.
28
M
Ureter
normal
98
8.
72
M
Bladder
normal
98
9.
62
M
Bladder
normal
98
Summary: 9 patients had an average rate of 1V2 X normal.
The temperature was normal in all patients, although 1 patient had a rate of 3 X normal, while
another had a rate of 4 X normal.
TABLE 10
Heart Disease
(With Failure)
Case
Age
: Sex
Complications
Rate
Temp.
1.
60
M
Pulmonary Infarction
5 X normal
100
2.
58
M
Pulmonary Infarction
2 X normal
98
3.
48
M
1% X normal
98
4.
61
M
normal
102
5.
72
M
Pulmonary Infarction
3 X normal
102
6.
77
F
normal
98
7.
60
F
3 X normal
98
8.
65
M
normal
99
9.
64
M
2% X normal
98
10.
57
M
Lues
2Y2 X normal
98
11.
67
M
2% X normal
98
12.
46
M
normal
98
13.
61
M
normal
98
14.
83
M
normal
98
15.
24
F
Chronic Adhesive Pericarditis
normal
98
16.
45
M
normal
100
17.
71
F
normal
98
18.
58
M
(Without Failure)
normal
98
1.
70
F
normal
98
2.
60
M
normal
98
3.
59
M
Lues
3 X normal
98.6
4.
72
M
Lues
normal
98
5.
61
F
(21 days after infarction)
normal
98
6.
61
M
(2 days after infarction)
normal
98
7.
60
M
(8 days after infarction)
normal
98
8.
46
M (2 months after infarction) normal
Summary: 18 patients with congestive failure had an average rate of 1^/^ X normal.
8 patients without congestive failure had an average rate of normal.
98
TABLE 11
Tuberculosis
Case Age Sex Location Complications Rate Temp.
1.
42
M
Hip
Abscess around joint
5 X normal
100
2.
57
F
Lung
4 X normal
100
3.
49
M
Bladder
(healed)
normal
98
4.
32
F
Femur
5 X normal
99
5.
50
M
Femur
3 X normal
98
6.
75
M
Femur
2 X normal
98
7.
33
M
Femur
Summary: 7 patients had an average rate of 3 X normal.
In only 2 patients did the temperature reach 100.
normal
98
Nineteen Hundred and Forty-two — April
77
TABLE 12
Anemias and Lei^kemias
Case
Age
Sex
Type
Hgb.
Blood Count
R. B. C. W. B. C.
Rate
Temp.
1.
65
F
P. A. (after 10 days of
39%
1,700,000
3,000
4 X normal
98
therapy)
54%
3,000,000
6,000
2 X normal
98
2.
70
M
Secondary (cause)
40%
2,700,000
6,000 •
3 X normal
98
3.
52
M
Secondary (papilloma of
bladder)
23%
1,280,000
9,000
normal
99
4.
66
M
Leukemia (myelogenous)
plus Polycythemia Vera
113%
5,900,000
125,000
normal
99
5.
56
M
P. A.
38%
1,800,000
4,000
. normal
98
6.
62
M
Chronic Lymphatic Leu-
kemia (acute exacer-
bation)
35,000
3 X normal
102
Summary:
2 patients with pernicious anemia were studied.
1 had before treatment a rate oi
; 4 X normal with a decrease of rate to 2 X normal after treat-
ment. Another had a normal rate
before treatment.
1 patient with secondary anemia
(cause unknown) had a
rate of 3
X normal, while a
second
patient with anemia, secondary to papilloma of bladder, had a :
normal rate.
1 patient with myelogenous leukemia plus polycythemia vera had a
normal rate.
1 patient with chronic lymphatic leukemia with acute exacerbation
had a rate of 3 X
normal.
TABLE 13
Arthritis
Case
Age
Sex
Type
Rate
Temp.
1.
18
M
Rheumatoid Arthritis (active)
3 X normal
98
2.
41
M
Rheumatoid Arthritis (active)
4 X normal
98
3.
85
M
Hypertrophic Arthritis
1)4 X normal
98
4.
60
M
Rheumatoid Arthritis (active)
3 X normal
98
5.
60
M
Rheumatoid Arthritis (inactive)
normal
98
6.
40
M
Rheumatoid Arthritis (inactive)
normal
98
7.
58
F
Hypertrophic Arthritis
normal
98
Summary:
: 3 patients with active rheumatoid arthritis had an average rate of 3 X normal.
2 patients, with inactive rheumatoid arthritis
had an average rate of normal.
2 patients with hypertrophic arthritis had an
average rate of normal.
TABLE 14
Brain (Traumatic, Vascular, and Abscess)
Case
Age
Sex
Type
Rate
Temp.
1.
49
M
Concussion
normal
98
2.
40
M
Fracture of Skull (bloody spinal fluid)
2 X normal
100
3.
44
M
Hemorrhage
normal
98
4.
72
M
Concussion
normal
98
5.
70
M
Thrombosis (arterial)
normal
98
6.
59
M
Thrombosis (arterial)
normal
98
7.
80
M
Thrombosis (arterial)
normal
98
8.
28
M
Abscess
3 X normal
100
9.
60
F
Thrombosis (arterial)
normal
98
10.
72
M
Concussion
normal
98
11.
80
M Thrombosis (arterial) 2 X normal
Summary: 4 patients with traumatic injuries had an average rate of 1)4 normal.
6 patients with vascular accidents had an average rate of normal.
1 patient with abscess had a rate of 3 X normal.
99
78
The Journal of the Maine Medical Association
TABLE 15
Congenital Anomalies
Case
Age
Sex
Type
Rate
Temp.
1.
18
F
Club Foot (before operation)
normal
98
2.
25
F
Dermoid Cyst, right ovary (before operation)
normal
98
3.
39
M
Scoliosis
normal
98
4.
38
M
Scoliosis
normal
98
5.
29
M
Cervicle Rib
normal
98
6.
10
M Club Foot
Summary: 6 patients with congenital anomalies had an
normal
individual rate of normal.
98
Time and space prevents ns from going
into detail with the clinical course of many
individual patients. However, we would like
to discuss briefly two patients ; one, a woman,
aged 32 when seen in October, 1936, with a
history of occasional joint soreness for five
years, presented a clear cut picture of active
rheumatoid arthritis with swollen knees and
ankles. In spite of these findings, the sedi-
mentation rate was only X normal and
at no time during her illness was it higher
than 2^ X normal. Treatment, including
vaccines, serums, a well-balanced diet and
physiotherapy, was without benefit and at the
time of her death from pneumonia two years
later she was approaching the state of a hope-
less cripple. The second patient, also a
woman, aged 59, when first seen in January,
1941, had pain and soreness in both hips
and shoulders with limitation of motion. The
blood sedimentation rate was 6 X normal,
although the temperature was 98.6. As both
symptoms and sedimentation rate remained
unchanged for two months, she consented to
tonsillectomy following which her condition
began to improve. The sedimentation rate
gradually fell with the gradual improvement
in symptoms and today is only 2 X normal.
We do not present these briefs to confuse,
perhaps further, the issue as to the clinical
merits of the blood sedimentation rate, but
only to show that originally high or relatively
low rates may have no bearing on the ulti-
mate outcome of the disease.
In presenting our findings in this series of
500 patients, no attempt has been made to
discuss the scientific side of the subject as we
feel this has been thoroughly covered in many
of the hundreds of articles published. Our
study has been wholly a clinical one.
After a brief glance at the findings in this
small group of patients, a few points seem
outstanding. First, generally speaking, in
many instances, the number of patients
studied here is actually too small from which
to draw definite conclusions. For example,
out of 26 patients with heart disease, we hap-
pened to have had only 4 with coronary
thrombosis on the wards at the time and 2 of
these had had their infarction well past the
time when the rate would have been in-
creased. The rates of all 4 were normal,
which our previous experience has shown is
directly oposite to what we usually find for
the first 2 weeks following an acute coronary
thrombosis.
Second, the sedimentation rate can be ex-
pected to be increased whenever there is an
increase in the fibrogen content of the blood
plasma, or an infiammatory or necrotic exu-
date being absorbed, and for these reasons it
is unreliable as a specific diagnostic test.
Third, there is no correlation between the
l)ody temperature and the blood sedimenta-
tion rate. Although the rate is frequently ele-
vated when the temperature is increased, a
high rate is not an uncommon finding in the
presence of a normal temperature.
Summary and Remarks
We have attempted to evaluate the rate of
the red blood cell sedimentation as a clinical
procedure. 150 patients were office patients
and the remaining 350 were on the wards of
the Maine General Hospital. In neither in-
stance were the patients selected, and no sepa-
ration into the different gToups was started
until the study was completed. Rates from
1^ to 2 X normal were considered slightly
Continued on page 85
Nineteen Hundred and Forty-two — April
79
Cancer Control in Maine, 1942
By ]\roETi:a£R AVaeeets, M. D,, PortlaiKB^^
and
IIeebeet R. Kobes, M. D., Angiista^-^
During the Legislative session of 1941
“An Act to Promote Cancer Control” was
passed. Its wording is “The department
(Health and AVelfare) is authorized to make
investigations concerning cancer, the preven-
tion and treatment thereof and the mortality
therefrom ; and to take such action as it may
deem will assist in bringing about a reduc-
tion in the mortality thereto.” All who read
this will immediately realize that this is a
very broad and liberal law. There are two
aspects to the law ; first, that of investigation
or research, and second that of activities to
reduce mortality in cancer — these activities
to be pointed out by the results of the inves-
tigations.
As soon as it was determined that the pro-
gram was to be carried out in the Division of
Medical Services in the Bureau of Health it
vras felt that a cooperative effort involving
the Cancer Committee of the TIaine Medical
Association, the Women’s Field Army, the
various tumor clinics, and the Bureau of
Health would gnarantee the best type of pro-
gram that could be given to the citizens of
Maine. You will remember that the Cancer
Exhibit at the June, 1941, State Medical
Meeting was sponsored by all these gTOups.
As the progTam develops other groups in the
medical, dental, nursing, and social service
professions will undoubtedly take part in
both planning and activities.
At a joint meeting of the Cancer Commit-
tee and the staff of the Bureau of Health
suggestions were formulated for the activities
of the various groups participating in the
program.
The Women’s Field Army will continue to
carry out a program of lay education using
the medical advice of the other cooperating
groups. A speaker’s bureau of physicians
should be built up and eventually should
include physicians from most of our com-
munities. Through funds raised by the
Yeomen’s Field Army x-ray and radium
therapy becomes available to patients who
otherwise could not he treated.
From the Annual Report of the State
Commander of the Women’s Field Army of
Maine (1941) we learn about the contribu-
tion of the Field Army toward x-ray and
radium treatment of cancer patients who
would not be able to care for this therapy
from their own funds.
Year
Number of Patients
Paid by Field Army
1937
123
$ 4,228.20
1938
276
6,629.21
1939
256
3,236.00
1940
287
14,060.96
1941
287
12,250.00
Total
1,229
$40,404.37
These payments did not.
of course, repre-
sent the total cost of care. For those patients
who had to be hospitalized to receive radia-
tion we learn that the State Hospital Aid
Division made considerable payment toward
the cost of care and in addition other funds
given by private agencies or individuals
helped obtain hospitalization. Many cases
which have received surgical treatment had
none of their care paid for by the Field
Army hut did have partial payment made
through State or other funds.
The present six tumor clinics are giving
a splendid service to the cancer patients of
Maine.
There is need for uniformity in recording
the cases and with this in mind the responsi-
bility for devising and supplying uniform
record forms was taken on by the Bureau
of Health. Such forms are now available for
the use of the tumor clinics and for all hos-
pitals and private physicians.
(1) Chairman, Cancer Committee of the Maine Medical Association.
(2) Director, Division of Medical Services, State Bureau of Health, Department of Health and Welfare.
80
The Journal of the Maine Medical Association
From the limited State appropriation some
payment is being made to aid defray in part
the cost of the necessary diagnostic proce-
dures carried out in the tumor clinics them-
selves. X-rays are frequently needed, espe-
cially to determine the presence of metas-
tases. All tumor clinics should have a biop-
sy or pathological specimen of every case be-
fore a positive diagnosis of cancer is made.
This procedure is absolutely necessary in the
determination of the so-called “five year
cures.”
The present tumor clinics at Portland,
Lewiston, Waterville and Bangor are so lo-
cated geographically that only a relatively
small part of Maine is covered adequately.
In the future other clinics should be estab-
lished to make available to patients the serv-
ices of the cancer progi’am. These additional
clinics in most instances will be for diagno-
sis, consultation and follow-up rather than
treatment. Since 1935 the vital statistics re-
ports (^) indicate that about 1,300 cancer
deaths have been reported annually. In 1940
the death rate for cancer for the United
States was 120.3 per 100,000 while that for
Maine was 155.0 per 1 00,000. (“). Regard-
less of the reasons for this higher rate in
Maine we know we have a definite problem
to face and since these deaths occur in all
sections of the State the present cancer con-
trol facilities, as represented by the tumor
clinics, should be extended to make them
available to all sections of Maine.
Physicians are more and more appreciat-
ing the value of group consultation for diag-
nosis and treatment of cancer. The interests
of both the physician and patient are protect-
ed by such group advice. Various cancer sta-
tistics derived from death reports, and the
impact of the war will all influence the estab-
lishing of new clinic centers.
The Cancer Committee recommended mak-
ing Cancer a reportable disease.
The Bureau of Health is taking under con-
sideration making available to tumor clinics
medical social service and clerical aid on a
part-time basis where these are not now avail-
able. The present tumor clinics almost all
feel acutely the need of some medical social
service. One of the most important phases
of cancer control is the follow-up service
which should be available to all cases. The
Bureau of Health through its Division of
Pidhic Health Xursing can render valuable
service to tumor clinics and physicians by
assisting in the follow-up of patients in their
homes. The necessity for return visits as
advised, the explanation to the patient and
family of the physician’s instructions and
methods of treatment are all part of follow-
up. Another important activity is the direct-
ing of arrangements for obtaining recom-
mended care when limited family resources
seem to prevent the physician’s advice from
being carried out. The Public Health Xurse
frequently knows available local resources
of which the family or physician may not be
aware.
Professional educational plans will need to
be made and at the present time it is felt
these should have the tumor clinics as focal
points. Cooperation with the Committee on
Post-Graduate Education of the Maine Med-
ical Association will be sought in fitting this
activity into those already underway in other
fields.
A heavy responsibility in cancer control is -
that which will come out of the development
of statistical research regarding cancer in
Maine. We need to know where our cancer
cases are and the varying rates of death due
to cancer in different counties and the rea-
sons for them. We have no compiled infor-
mation relative to the incidence of different
types of cancer in different areas of the State.
Essential to an adequate program are the
answers to all these problems and many
others. These answers will not be arrived at
in a day and many individuals and groups
will be asked to aid in obtaining them. The
responsibility for gathering the material will
be given to the Bureau of Health.
This is the first of a series of reports re-
garding the Cancer Control Program which
will appear from time to time in The Jour-
XAE OF THE MaiNE MehICAE AsSOCIATIOH.
(1) 48th Annual Report upon the Births, Mar-
riages, Divorces and Deaths in the State of
Maine, p. 96.
(2) Bureau of the Census, Vital Statistics, Special
Reports, Vol. 15, No. 7, p. 76.
Nineteen Hundred and Forty-two — April
81
Plan for Blood and Plasma Banks, State of Maine
Julius Gottlieb, M. D., F. A. C. P.", and Gilbebt Clappertojst, M. D.
Part I
The value of plasma banks has been re-
cently stressed by all agencies devoted to
Medical Defense activities. The general
principle that each locality must assume the
responsibilities inherent in its Civilian De-
fense efforts, particularly holds with respect
to the creation of Plasma Banks for its use
in the event of catastrophes arising as the re-
sult of enemy attack. No segment of the popu-
lation can nor should be expected to provide
plasma for Civilian Defense for groups of in-
dividuals elsewhere. There is only one source
of human blood plasma for any commnnity,
and that source obviously is the constituents
of that community. The only exception to
this general proposition is the provision of
plasma to the armed forces and to such com-
munities that have not adequately prepared
for a catastrophe when stricken. At the pres-
ent writing, there appears no exception for
any community to divorce itself from the re-
sponsibility of providing plasma for its po-
tential use.
The following plan is recommended to the
State of Maine Medical Director for Civilian
Defense to be modified as may be needed in
each and any of its communities, or groups
of communities participating in the creation
of a reserve of blood plasma.
Oroaxization :
A- — The general structure of the organiza-
tion for Blood and Plasma Banks throughout
the State follow the pattern as outlined in
the diagrammatic schema, coordinated under
the office of the IMedical Director for Civilian
Defense. (1)
Plan for Blood and Plasma Banks
* From the Central Maine Blood and Plasma Bank Fund.
82
B — That the committee suggested hj your
office comprised of Pathologists shall act in
an advisory capacity, and shall be in direct
communication with the Medical Director
and respective chairmen of the. various hos-
pitals. (3)
C — That a central director be appointed
who shall have complete supervision of the
Blood Bank at each of the centers throughout
the State, and that not more than four and
not less than three such central hanks be es-
tablished. The central director shall be re-
sponsible for the collections, storage, proces-
sing and dispensing of the Blood and Plasma
Banks. (Y)
D — It is further recommended that repre-
sentatives (3) of the Board of Directors,
comprised of the chairman of the Board of
Trustees, the Superintendent and Treasurer
be responsible for all finances and personnel
pertaining to each of the central banks to
whom the central director be directly respon-
sible. It is essential that all regulations per-
taining to the conduct of each of the central
banks be approved by the central hospital
board. (3)
E- — It is further recommended that at
each center a finance committee (5) be ap-
pointed whose functions shall be the obtain-
ing of funds as may be necessary at each
center.
F — It is recommended that a central hos-
pital donor procurement committee (8) be
appointed whose function shall be obtain-
ment of blood donors and the transportation
of Plasma for the various local centers. It is
suggested that the Women’s Hospital Asso-
ciation, or its equivalent be assigned these
functions.
G — It is recommended that each local unit
appoint a local Medical Director, (10) a
financial committee (6) and a donor procure-
ment committee, (9) whose respective func-
tions be analogous to similar committees of
each of the central banks.
H — It is recommended that each center
take advantage of the Bingham Associates
Education and Consultation services, (11)
including refresher course for physicians,
The Journal of the Maine Medical Association
technicians and nurses engaged in the cen-
tral Blood and Plasma Banks.
d — It is also suggested that a vohrnteer or-
ganization be established at each station,
(12) both central and local, comprising a
canteen, nursing and aide service, whose
functions shall be as may be directed by each
of the Medical Directors at the time of blood
procurement clinics.
K — Each center shall engage a full time
nurse (13) and part time technician (15)
responsible to the Central Director for all
duties pertaining to the central bank.
Foems :
It is recommended that uniform forms be
prepared by each of the centers to be dis-
tributed to their various associated units,
particularly in reference to registration
blaiiks, data sheets pertaining to physical
examinations, record blanks to be retained
at each center and certification cards of
donors ; as well as a uniform system of
bookkeeping and tagging of blood specimens.
Technique :
Insofar as possible, it is recommended that
technical procedures pertaining to blood pro-
curement, processing, storage and dispensing
be uniform in each of the centers, as well as
the technique pertaining to typing, serologi-
cal and bacteriological procedures. Recogni-
tion, however, of accepted methods of each of
the centers pertaining to technique is essen-
tial.
Dispensing of Plasma:
The dispensation of Plasma must be guided
by the general principle that the efforts of
the Plasma Bank are directed towards the
creation of the supply of Plasma that may
be needed in the event of a catastrophe at any
of the centers or its subdivisions. Require-
ments for Blood Plasma arising out of the
usual emergencies must therefore be met in
the usual manner now obtaining at the va-
rious hospitals throughout the State ; or as
may be created as a function distinct from
this emergency defense effort. Under unusual
circumstances, however, available Plasma
may be obtained for other purposes if and
Nineteen Hundred and Forty-two — April
83
■only when snch Plasma can he replaced by
an equivalent of blood or monetary compen-
sation, which in either event shall accrue to
the Blood and Plasma Banks. In the event
of a monetary exchange, a charge equivalent
to prevailing market price shall be made. In
the event of an exchange of blood equivalents,
it is recommended that 250 cc. of blood be
delivered for each 100 cc. of Blood Plasma.
This is to be exclusive of any charge that any
institution or individual may make for serv-
ices pertaining to a transfusion in question.
Ob.jective :
It is recommended that each center aim to
accumulate one thousand 500 cc. flasks in
frozen state, approximately half of which is
to be stored at the central station and the
remainder at the various local stations and
strategic sites. Each locality shall be entitled
to any available supply of Plasma in the
event of catastrophe.
Fixaxces :
Insofar as possible, each center and its
subdivisions shall solicit contributions for
the support of these banks to be augmented
by funds that may become available through
the iMedical Director of Civilian Defense.
Note: Part II will deal with a more
detailed description of the organization of
the Central iMaine Blood and Plasma Bank
Fund and the technique employed in the
collection, processing, storage and dispensing
of Blood Plasma, adapted to the general })lan
outlined above.
The 15th Early Diagnosis Campaign for the
Prevention of Tuberculosis
It is an important fact to remember that
Tuberculosis can exist without sigus or symp-
toms, and to discover the presence of Tuber-
culosis infection before any physical signs or
illness appears, we have the tuberculin test,
a harmless skin test. If this test is positive it
means there are tuberculosis germs present
in the body, but it does not tell whether or
not such germs are active or doing damage.
If the skin test is positive an x-ray picture of
the lungs should be taken and if the x-ray
shows tuberculous shadows the films should
be read by a physician with special training
and experience to determine whether there
should be a lung examination made. Several
sputum tests should always follow an x-ray
showing significant changes in the lungs, but
tubercle bacilli are only found if the disease
has become an ‘‘open case.”
It is only throngh the use of modern case
finding methods leading to an early diagno-
sis and isolation of all open cases and con-
tinuation of education of the public that we
shall conquer Tuberculosis. Great progress
has been made in the prevention and treat-
ment of Tuberculosis and the death rate has
been cut down more than three-fourths of the
rate found in 1900, but there are still 100
out of every two hundred persons infected
with the germs of Tuberculosis.
Tuberculosis still kills one out of every
twenty persons and no other disease kills so
many people between the ages of fifteen and
fortv-flve. lYars have always brought an in-
crease in Tuberculosis and the age-group
between twenty and fortv-flve is the most es-
sential one in time of war. It is not only the
men in the armed service, but it is found
that behind every man in uniform it takes
eighteen men and women in overalls on
farms and in factories to supply the need of
one soldier, so we might use a war cry of
“No Victory Without Health.”
Prevention of disease is a large part of
Civilian Defense. I'he war effort needs all
our productive strength and as most of the
victims of tuberculosis are workers and
housewives, both are needed for Home De-
fense. Tuberculosis must not be permitted to
weaken our Home Defense. The Maine Pub-
lic Health Association with its nineteen affili-
ated services is conducting the 15th Early
Diagnosis Campaign this year from April
1 to April 30 and Mrs. Maude Clark Gay,
of Waldoboro is State Chairman. The slogan
for the 15th Early Diagnosis Campaign is
TUBEBCLTLOSIS
EIGHT IT
TEEAT IT
COXQUEE IT
84 The Journal of the Maine Medical Association
Editorial
National Cancer Control Month
By special Act of Congress April lias been
designated as ISTational Cancer Control
Month. Again the Women’s Field Army will
conduct its annual campaign for material
and deserved support by way of contribu-
tions that its educational efforts may con-
tinue successfully, as they must. It is ex-
tremely probable that the Post Office Depart-
ment will authorize the issue of a special
cancer stamp, which daily reminder — it is
hoped — will augment in no small way the
battle that is being fought with success
against maligaiant disease. Since 193Y the
work of the Women’s Field Army in Alaine
has shown increasingly tangible results that
educational efforts are well worth the time
and money expended. It is the good fortune
of the physicians and people of Maine to
have even more than this valuable service, for
a very material amount of financial assis-
tance has been afforded properly certified
and recommended patients to obtain x-ray
and radium treatments since many patients
seen in and referred to the tumor clinics are
unable to bear this burden in whole or part.
This assistance has l)een made possible by the
Army Scannell fund together with a special
allotment by the State and the number of
patients who require financial help is yearly
increasing.
To progress means moving forward, ad-
vancing and increasing in proficiency, and
the records of Maine and certain other states
shows facts that are ('xtremely gratifying and
hopeful, not only in the technical methods
dealing with certain types of malignancy,
but a seeming appreciation by the public as
demonstrated by the increasing number of
patients applying for diagnostic consultation.
While the financial demands required to
combat the challenge to our verv existence
have soared into astronomical figures the war
against disease must continue; it would be
the height of folly to minimize our efforts in
any way.
The campaign of the Field Army will not
have the dramatic appeal and popular pub-
licity enjoyed by certain efforts connected
with fSTational defense, and public meetings
on the subject of cancer can hardly be ex-
pected to compete in interest with those of a
different nature. However, the tragedy of
delay in the diagnosis and treatment of ma-
lignancy cannot be too emjDhatically or often
stressed and it is extremely important that
any given patient with suspected or question-
able malignant disease obtain the service
which will remove the prol)leni from one of
doubt to certainty if humanly possible.
Research, more and better facilities for
the care of the indigent sick, the development
of more special clinics and hospitals, are all
important aspects of a cancer control cam-
paign but not a whit more than preventing
thousands from becoming hopelessly, incur-
ably ill. The family physician is the one
who usually sees the average patient when
the problem is diagnostic. As a rule the pa-
tients and those near and dear to them seek an
intelligent answer to their fears, justified or
not, and to expose any patient to the dangers
inherent in delay, uncertainty or unwarrant-
ed false security is not an application of the
Golden Rule. The demands on hospitals,
clinicians and clinics are increasing. That
increase must be met and again the Jourxax,
speaks for and in behalf of the campaign for
this most meritorious cause.
Complacency would be stupid while tuber-
culosis is still causing more deaths in this
country than any other communicable dis-
ease except pneumonia, and while there are
less than a hundred thousand sanatorium
beds to care for half a million people with
recognizable clinical infection. — Geddes
Smith, ‘'Plague on Us/' pub. by Common-
wealth Fund, 1941.
Nineteen Hundred and Forty-two — April 85
The Ninetieth Annual Session
The aiiiiiial session of The Maine Medical
Association will be held at the Poland Spring
House, Poland, Sunday, Monday, and Tues-
day, June 21, 22, and 23. The accommoda-
tions, the general atmosphere with its pano-
ramic view, and being so readily accessible,
The Poland Spring House is no doubt the
most outstanding place in Maine for conven-
tions. Onr last meeting held there received
the greatest turnout in the history of the
Association. This year, in particular, should
be well attended, as each member should
avail himself with all possible information,
to better cope with what may be the most
trying conditions that the medical profession
has ever had to deal.
Much of the program for the three days is
already completed in detail. The entertain-
ment for Sunday evening is to be somewhat
different from that of the past and will be of
interest to the ladies as well. The chairmen
of the various conferences have been most
prompt in working up their subjects. Each
conference has been seriously considered and
should be of much interest and value. The
next issue of the Jouexal will contain much
in detail concerning the conferences and the
afternoon program. The speaker for the
banquet will put a lot of punch into the last
day, and it is expected that many will come
solely to hear Dr. Fishbein.
Bring the ladies and your golf clubs. Ho
one knows what next year will have in store,
so let’s make this a grand get-together.
C. C. Weymouth, M. D.,
Chairman Scientific Committee.
Continued from 'page 78
elevated, and more than 3 X normal mark-
edly elevated.
The rate was found to be definitely ele-
vated in acute pyogenic infections, in pneu-
monia, in tuberculosis, in malignant tumors,
in fractures, in the last six months of preg-
nancy and during postpartum, in active
rheumatoid arthritis, and following abdomi-
nal operations. The rate was consistently nor-
mal in nervous and mental diseases, in benign
tumors, in sprains, skin lacerations, and in
diabetes mellitus.
It has been said that the use of the blood
sedimentation rate tells the experienced per-
son much, but that it may lead the inexperi-
enced astray. With the exception of preg-
nancy, the organically healthy individual
should not have an elevated rate ; but an ele-
vated rate is not specific for any one disease.
The sedimentation rate is many times useful
as a follow up to check the progvess of the
disease or the recovery of the patient. How-
ever, this, too, is far from infallible, as a tem-
porary — perhaps unrecognized — complica-
tion may itself elevate the rate.
Therefore, we feel that the blood sedimen-
tation rate is a practical, simple laboratory
procedure which should be of considerable
use in the hands of those who understand its
limitations.
1. Fahraeus, R.: The Suspension-Stability of the
Blood. Acta Med. Scandinav. 55: 1-228, 1921.
Ibid. Physiol. 9: 241-274, 1929.
2. Cutler, J. W.: The Practical Application of the
Blood Sedimentation Test in General Medicine.
Am. J. M. Soc. 183: 643, (May) 1932.
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86
The Journal of the Maine Medical Association
County News and Notes
100% Paid-Up Membership
for 1942
Piscataquis County Medical Society
Franklin County Medical Society
Washington County Medical Society
Lincoln-Sagadahoc Medical Society
Hancock County Medical Society
Oxford County Medical Society
Aroostook
A clinic and luncheon meeting of the Aroostook
County Medical Society was held Friday, October
24, 1941, at Presque Isle, Maine.
The following cases were presented at the
Clinic;
(1) Asthmatic bronchitis and infantile eczema.
(2) The backward child.
(3) Stomatitis in infants.
(4) Stigmata of prolonged malnutrition.
At the noon luncheon at the Northeastland Ho-
tel, Herbert E. Locke, Attorney, of Augusta, spoke
on malpractice suits and means of avoiding them.
Francis McDonald, M. D., of the Floating Hos-
pital, Boston, spoke on the Appraisal of the Child.
P. L. B. Ebbett, M. D., President of the Maine
Medical Association and Norman H. Nickerson,
M. D., Councilor of the Sixth District, were present.
Gerald H. Donahue, M. D.,
Secretary.
Cumberland
The 163rd meeting of the Cumberland County
Medical Society was held Friday, February 27,
1942, at the Eastland Hotel, Portland, Maine, at
6.30 P. M. The President, Roland B. Moore, M. D.,
presided.
The speaker of the evening was Chester Keefer,
M. D., of the Massachusetts Memorial Hospital,
Boston, whose subject was The Treatment of Bac-
terial Meningitis. His paper was discussed by Drs.
Henry P. Johnson, Mortimer Warren, Joseph E.
Porter, Alice A. S. Whittier, and Hirsh Sulkowitch.
Eugene P. McManamy, M. D., was admitted to
membership by transfer from the Olnisted-Houston-
Fillmore-Dodge County Society, of Minnesota.
The application of Lawrence W. Conneen, M. D.,
was received and referred to the Council.
The meeting was preceded by a Clinic at the
Maine General Hospital at 5.00 P. M.
Eugene E. O’Donnell, M. D.,
Secretary.
Kennebec
A meeting of the Kennebec County Medical Asso-
ciation was held at the Gardiner General Hospital,
Gardiner, Maine, Thursday, March 19, 1942.
Clinical program at 5 P. M., which was presided
over by L. Armand Guite, M. D., President:
1. Possible Case of Multiple Sclerosis — Henry
Almond, M. D.
2. Retained Placenta — I. E. McLaughlin, M. D.
3. Two Cases of Angina Pectoris — Fred Strout,
M. D.
4. A Base of Pneumonia — C. R. McLaughlin,
M. D.
5. An Unusual Case of Diabetes in a Child —
A. B. Libby, M. D.
6. Breast Carcinoma of Twelve Years' Duration
— F. B. Bull, M. D.
7. Aneurysm of the Femoral Artery — S. 0. Cla-
son, M. D.
8. Lymphosarcoma of the Tonsil — A. C. Hurd,
M. D.
Dinner at 6.30 P. M., which was followed by a
business meeting. Minutes of the last meeting were
read and approved.
T. Dennie Pratt, M. D., of Waterville, Maine, was
elected to membership.
The speaker of the evening was Hollis L.
Albright, M. D., Visiting Surgeon at the Massa-
chusetts General Hospital, The Baptist and the
Deaconess Hospitals, and Instructor of Surgery at
Boston University. His subject was Management
of Hyperthyroidism. This paper was amplified by
lantern slides, and was very interesting and in-
structive.
There were 35 members and guests present.
Respectfully submitted,
Frederick R. Carter, M. D.,
Secretary.
Knox
A meeting of the Knox County Medical Society
was held at Rockland, Maine, Tuesday, January
13, 1942.
The meeting was called to order by James Cars-
well, M. D., President, who appealed to the doctors
for volunteer teachers for the Red Cross. The fol-
lowing doctors volunteered their services: Gilmore
W. Soule, Neil A. Fogg, and Wesley Wasgatt, of Rock-
land; Saul R. Polisner and James Carswell of
Camden; Frederick Dennison of Thomaston; and
Paul A. Jones of Union.
S. H. Proger, M. D., of the Pratt Diagnostic Hos-
pital, Boston, who was the guest speaker, gave
some case histories illustrating troublesome med-
ical conditions and conducted an open discussion
of each case. Many interesting points were brought
up, and much interest shown regarding newer
ideas.
A. J. Fuller, M. D.,
Secretary.
A meeting of the Knox County Medical Society
was held at the Copper Kettle, Rockland, Maine,
Tuesday, February 10, 1942. The President, James
Carswell, M. D., presided.
This meeting was called to review matters not
already clarified and to check on the defense
program.
C. Harold Jameson, M. D., spoke first on the
Plasma Bank being set up in Lewiston, and work-
ing through the Bingham Associate Hospitals.
Neil A. Fogg, M. D., spoke on Plasma.
Walter D. Hall, M. D., gave an outline of the
87
Nineteen Hundred and Forty-two — April
defense locations and the capacity for casualties,
and the arrangements for sifting out cases to avoid
overloading hospitals.
Frederick Dennison, M. D., of Thomaston, and
Saul R. Polisner, M. D„ of Camden, told about the
set-up in their towns.
Howard L. Appollonio, M. D., on leave from
Military Service, spoke on First Aid.
A. J. Fuller, M. D.,
Secretary.
The regular monthly meeting of the Penobscot
County Medical Association was held on Tuesday,
February 17, 1942, at Bangor, Maine.
At the business meeting, two new members were
accepted as follows: Jay K. Oslar, M. D., Bangor,
by transfer from the Kings County Society, New
York. Doctor Oslar is associated with Manning C.
Moulton, M. D., in the practice of Ophthalmology.
Benjamin L. Shapero, M. D., Bangor, who will
specialize in Internal Medicine.
The speaker of the evening was Chester M. Jones,
M. D., Clinical Professor of Medicine, Harvard
Medical School. His subject was “Thoracic and
Upper Abdominal Pain; Its Significance and Dif-
ferential Diagnosis.”
There were 44 present.
Forrest B. Ames, M. D.,
Secretary.
New Members
Aroostook
H. F. Kelloch, M. D., Ft. Fairfield, Maine.
Cumberland
Eugene P. McManamy, M. D., 29 Deering Street,
Portland, Maine.
Kennebec
T. Dennie Pratt, M. D., Waterville, Maine.
Lincoln-Sagadahoc
H. C. Barroics, M. D., Boothbay Harbor, Maine.
C. E. Bousfield, M. D., Woolwich, Maine.
H. E. Fernald, M. D., East Boothbay, Maine.
Rufus E. Stets07i, M. D., Damariscotta, Maine.
Penobscot
Jay 'K. Oslar, M.D., 150 State Street, Bangor,
Maine (by transfer from the Kings County Society,
New York) .
Benjamin L. Shapero, M. D., 73 Broadway, Ban-
gor, Maine.
Deaths
A ndroscoggin
Joseph Oswald Marien, M. D., 47, at Lewiston,
Maine, March 6, 1942.
Cumberland
William Delue Anderson, M. D., 61, at South
Portland, Maine, March 1, 1942.
iiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiim^
I California i
I WINES I
I invite attention |
iiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiii^^^
AMERICA TODAY, the wines of our
own country are used nine to one over
foreign wines.
Especially favored are the wines of California,
For in the opinion of authorities qualified to
speak, California is producing wines of out-
standing quality.
This quality begins with the grapes them-
selves. For example, in California’s yoo-mile
vineyard belt there occurs a range of soils and
climates in which the world’s finest wine grapes
are grown. Somewhere in the state each grape
variety finds its ideal setting and comes to per-
fect ripeness each year.
Just as essential, American wine-growing
skills and facilities have now advanced over any
before known in this country. Special methods
of grape selection, temperature control, and
sanitation, continuing laboratory tests, and
spotless modern equipment today aid the wine
grower in the United States.
In every way California wines conform to
the most rigid State and Federal standards of
quality. All are well developed. True to type.
And these fine wines are moderate in price —
perhaps an important point to many people
who now find wines of Europe too expensive.
This advertisement is printed by the
wine growers of California acting through
the Wine Advisory Board, 8^ Second
Street, San Francisco. The non-profit
Wine Advisory Board invites your re-
quests for further information about
California wines.
88
The Journal of the Maine Medical Association
Coming Meetings
National Medical Societies
American Medical Association
Olin West, M. D„ 535 North Dearborn
Street, Chicago, Secretary.
Annual Meeting — Atlantic City, June 8-12,
1942.
State Medical Societies
Connecticut State Medical Society
Creighton Barker, M. D., 258 Church
Street, New Haven, Secretary.
Annual Meeting — Middletown, June 3-4, 1942.
Maine Medical Association
Frederick R. Carter, M. D., 142 High
Street, Portland, Secretary.
Annual Meeting — Poland Spring, June 21-23,
1942.
Massachusetts Medical Society
Michael A. Tighe, M. D., 8 The Fenway,
Boston, Secretary.
Annual Meeting — Boston, May 26-27, 1942.
New Hampshire Medical Society
C. R. Metcalf, M. D., 5 South State Street,
Concord, Secretary.
Annual Meeting — Manchester, May 12-13, 1942.
Rhode Island Medical Society
W. P. Buffum, M. D., 122 Waterman Street,
Providence, Secretary.
Annual Meeting — Providence, June 3-4, 1942.
Vermont State Medicai Society
Benjamin F. Cook, M. D,, 154 Bellevue
Avenue, Rutland, Secretary.
Annual Meeting — Bennington, October, 1942.
Convention Rates
1942 Annual Session
Poland Spring House, Poland Spring, Me.
June 21, 22, 23, 1942
The following room rates, which include all
meals, will prevail:
Single rooms without bath $6.00 per day
Double rooms without bath, per per-
son $6.00 per day
Double room and single room with
connecting bath, for 3 persons,
per person $7.00 per day
Two double rooms with connecting
bath for 4 persons, per person ....$7.00 per day
Double room with bath for 2 persons,
per person $7.00 per day
Single room with bath, per person $8.00 per day
The charge for non-registered guests for meals
will be as follows:
Breakfast $1.00
Luncheon $2.00
Dinner $2.50
Golf green fees will be $1.00 per day. The tennis
courts and Beach Club will be available without
charge.
The Hotel Orchestra will be available four hours
each day for dancing.
For reservations write the Poland Spring House,
Poland Spring, Maine.
Make Your Reservations Early
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cancer sufferers in 1942. Help us
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If you live in the Metropolitan Area,
address the New York City Cancer
Committee, 130 East 66th Street.
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New York, New York
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The Journal
of the
Maine Medical Association
Uolume Thirlij-'ihree Portland, Ulaine, Mai^, 1942 No. 5
The Slipping Rib Cartilage Syndrome with Report of Cases^
By Johjst F. Holmes, M. D., F. A, C. S., Manchester, ISf. H.f
The purpose of this paper is to call atten-
tion to a group of symptoms, notably painful
symptoms, involving the rib borders, the
chest, the abdomen, and the hack, which are
associated with abnormal mobility and de-
formity of the anterior ends of the anterior
cartilages of the costovertebral ribs, namely,
the eighth, ninth, and tenth on either side,
and to describe observations made over a
period of twenty-nine years, particularly em-
phasizing persistent and incapacitating symp-
toms relieved by a simple operation.
But little has been written on the subject,
and scarcely any attention paid to it in text-
books ; moreover, since there does not appear
to be any general understanding as to what it
is, why it occurs, or how the symptoms are
produced, it seems advisable to include here
much of the material presented in my origi-
nal paper, A Study of the Slipping Rib Car-
tilage Syndrome,} and a subsequent paper.
Slipping Rib Cartilage with Report of
Casesd Let me state clearly at the beginning
that this syndrome is concerned with the an-
terior ends of the anterior rib cartilages, their
interchondral articulations, and the closely
related intercostal nerves. It does not involve
the osteochondral junction of the anterior
ends of the ribs ; and, barring anomalies, mis-
takes in numbering the ribs, and exceptions,
it includes only the anterior cartilages of the
first three false ribs, anatomically designated
vertebrochondral ribs, which are the eighth,
ninth, and tenth on either side.
This symptom complex was first reported
by Cyriax,® of London, in the Practitioner,
1919, under the caption:
“OiT Yaeiotjs Conditions That May
Simulate the Refereed Pains of Vis-
ceral Disease and a Consideration op
These From a Point of View of Cause
AND Effect.”
In 1922, under the original title. Slipping
Rib, Davies-Colley,^ of London, described
two cases of anterior-end anterior rib carti-
lage displacement which he had operated
upon by resection of the loosened cartilage
with “complete relief of symptoms.”
From this time until 1924 there were pub-
lished, in the British Medical J ournal, under
the heading. Slipping Rib, eight other cases
by five authors — Poynton,® of London, three
cases ; Soltau,® of Illfracrombie, one case ;
Marshall,’^ of London, one case ; Mahon,® of
t Surgeon, Elliott Hospital, Manchester, and Hillsborough General Hospital, Grasmere, New Hamp-
shire. Consulting Surgeon, Cottage Hospital, Exeter, New Hampshire, Alexander-Eastman Hospital, Derry,
New Hampshire, and Waldo County Hospital, Belfast, Maine.
* Presented at the 89th Annual Session of the Maine Medical Association, York Harbor, Maine, June,
1941.
90
Galway, Ireland, two cases ; Russell,® of Alex-
andria, Egypt, one case. Of these eight cases,
three were operated upon with cure.
In 1931, Bisgard,^® of Chicago, referred to
Davies-Colley’s article and reported one case,
from the University of Chicago clinics, which
he had operated upon with cure.
In this same year. Darby," of Vancouver,
Washington, reported one case also operated
upon by resection of the rib cartilage, with
relief of symptoms.
This makes a total of fifteen cases pub-
lished in medical journals from 1919 to 1931,
eight of which were operated upon with cure.
Davies-Colley,^ noted : “It is probably not
a rare condition and is a trivial enough com-
plaint in itself but it gives rise to most irk-
some symptoms. ... In its (the pain’s) po-
sition at the costal margin it resembles that
due to so many deeper lesions of the abdomen
and thorax, that I think it is quite likely that
many cases occur in which such an apparently
unimportant cause as a movable rib cartilage
is unsuspected and the diagnosis missed.”
Slipping rib cartilage is of common occur-
ence, and often produces irksome, incapaci-
tating symptoms. It is diagnosed by physical
examination, and cured by a simple operative
procedure. As stated by Davies-Colley,^ “it
is curious that it should receive no recogni-
tion in modern textbooks of surgery,” and by
Bisgard,^® “it has received but little attention
in medical literature.”
Because of failure to recognize this symp-
tom syndrome, needless laparotomies have
been performed, and prolonged suffering and
incapacity from an easily curable condition
are often permitted. These facts justify an
attempt to secure a better understanding and
a more general recognition of this entity.
The loosening and deformity of the an-
terior ends of the anterior cartilages of the
vertebrochondral ribs begin first by a pulling
away of the fibrous attachment of the anterior
end of the cartilage. The deformity is the
result of displacement of a fracture fragment
or a dislocated cartilage ; or, as is usually the
case, by a curling upward of the loosened car-
tilage-end so that, on motion, the deformed
end rubs against the inside of the rib carti-
lage above and against the intercostal nerve,
causing pain ; also, on certain motions and on
manipulation, the deformed end slips over
The Journal of the Maine Medical Association
the rib border with a click that usually can be
felt and heard, and a pain that is often severe.
Figure 1, an anatomical diagram of the
framework of the anterior chest wall from
Gray’s Anatomy indicates that the anterior
ends of the anterior cartilages of the eighth,
ninth, and tenth ribs are normally connected
to the ones above, not by a cartilaginous
union, l>ut by a fibrous attachment. Less
clearly shown, but easily demonstrable, is a
fibrous hammock supporting the cartilage end
and enclosing the interchondral articulation.
This encircling type of attachment lends to
the desirable mobility of the lower chest wall
and rib liorders, but at the same time it has
the instability characteristic of any joint, and
hence the susceptibility to trauma. Impor-
tant to remember here in the consideration of
cause and eftect is the statement of Lilien-
thaT^ in his book Thoracic Surgery, “the
weakest part of the thorax is along the costo-
chondral line on either side.” One should
bear in mind also, with reference to etiology
and symptoms, the various muscle attach-
ments in this region with their divergent
pulls, the nerve supplies involved, and the
constant respiratory motion.
The intercostal muscles, internal and ex-
ternal, occupy the intercostal spaces. They
act to stabilize the chest wall and particularly
the intercostal spaces. Their nerve supply is
from the intercostals.
The diaphragm arises from the ensiform
process, from the rib borders, from the lumbo-
Nineteen Hundred and Forty-two — May
91
costal aponeurotic arches, and from the lum-
bar vertebrae ; it is inserted into a central
tendon. Contraction of the muscle lowers the
diaphragm, exerting a strong pull on the rib
borders. All expulsive acts, such as coughing,
defecation, and the expulsive effort of child-
birth, are preceded by a deep inspiration as
the diaphragm is called into action to give
additional power to abdominal compression.
The nerve supply is from the phrenic and
lower intercostals.
The abdominal muscles, transversus, inter-
nus and externus, are all attached to the rib
borders and the cartilages in question. They
function to compress the abdomen in the ef-
fort of expulsion, and to flex the body, as in
climbing, thus exerting a strong pull on the
cartilages of the costal margins. The nerve
supply of these muscles comes from the inter-
costals and the lumbar plexus.
The Serratus anterior is attached to the rib
border, to the ribs of the anterior chest, and
to the scapula. It functions as a whole to
carry the scapula forward, and is therefore
concerned in the act of pushing. It stabilizes
the scapula, and assists the Trapezius in mo-
tions of the sterno-clavicular joint, the DeT
toidius in raising the arm, and may assist in
raising and everting the ribs. Its nerve sup-
ply is from the long thoracic which is derived
from the fifth, sixth, and seventh cervicals by
way of the brachial plexus.
The Latissimus dorsi has an attachment at
the rib border, and passes upward, converging
into a tendon which is inserted into the up-
per anterior aspect of the humerus below the
lesser tuberosity. Its motion is concerned
with the downward pull of the arms, as in
felling a tree and in golfing, as well as to as-
sist the pectoral and the abdominal muscles
in body flexion. Its nerve supply is from the
long thoracic.
All of the muscles described above are at-
tached, in part, to the anterior cartilages of
the eighth, ninth, and tenth ribs. Posteriorly
attached to the lower ribs, coming from above
and below, are the deep muscles of the back.
Their action is to assist in bending and stabi-
lizing the spinal column and the trunk.
Their nerve supply is from the posterior pri-
mary division of the spinal nerves, closely
associated with the sympathetics.
I have mentioned the muscles directly at-
tached to the eighth, ninth, and tenth ribs
and their cartilages, and have named their
nerve supplies which are widely distributed ;
but other muscles and nerves are involved in
the intricate processes of motion at the rib
borders. The above is sufiicient to suggest an
explanation for the many signs and symp-
toms that characterize the syndrome of the
slipping rib cartilage.
Etiology
Abnormal mobility of these rib-cartilage
ends may begin acutely as a result of frac-
ture or dislocation of the cartilage, or more
often, as a partial separation of the fibrous
attachment. On the other hand, it may be
the result of multiple injuries, which have
stretched the fibrous attachment over a period
of time — as from golfing or one-sided weight
carrying. That trauma, direct or indirect, is
the etiological background seems reasonable.
Ballon and Spector^^ report eight cases,
under the title Slipping Rih; and state in
summary, ^Bn most instances the slipping rib
developed as a result of injury, but the pa-
tient frequently failed to attach any impor-
tance to the injury.”
Deformity of the loosened cartilage-end
may result from displacement of a fracture,
or dislocation, as appeared in two cases; but
is more often due to a curling upward of the
loosened cartilage-end so that it rises above
the contiguous rib cartilage, mechanically
slipping out and in over the superior carti-
lage on certain movements of the chest or
arms, or by digital manipulation, with a click
and a pain that are diagnostic.
From an analysis of 68 cases, 16 reported
prior to 1938,* 7 by personal communica-
tion, and 46 of my own, it appears that slip-
ping rib cartilage results more often from
indirect than from direct trauma, there being
36 of the former and 14 of the latter; in 6
cases, both direct and indirect force were in
evidence. In the remaining 12 cases no at-
tempt was made to establish a cause, due, I
believe, to incomplete histories. It is usually
necessary to retake the histories of these
cases ; for, since the cartilage deformity al-
most always develops over a period of time
* The eight cases of Ballon and Spector are not included in this analysis.
92
subsequent to the trauma, the patient fre-
quently does not associate the injury with the
complaint, and the cause is not recognized.
This is especially true of indirect injury,
where, as in coughing or in childbirth, and
so forth, the trauma itself is frequently not
recognized.
A sudden blow of the steering wheel of an
automobile against the lower ribs is one
method of direct injury. Indirectly it may
be caused by sudden flexion, extension or
twisting of the body; by repeated distortion
of the body, as the one-sided weight carrying
of an industrial worker; by a sudden pull on
the arms, as in weight lifting or pushing ; by
forced compression or expansion of the chest,
as in childbirth or coughing; and by many
other types of force.
In his original report of this entity,
Cyriax® said: “Pain and tenderness pro-
duced by displacement of the anterior ends of
the ribs or cartilages is doubtless due to irri-
tation of the intercostal nerves in the vicinity,
from which it may radiate to the posterior
spinal nerves and thence to the thoracic or
abdominal sympathetics.”
Figure 2, from Gray’s Anatomy,^" shows
the logic of this statement. According to
Gray,^^ the intercostal nerves “pass forward
in the intercostal spaces below the intercostal
vessels.” The description continues : “at the
back of the chest they lie between the pleura
and the posterior intercostal membranes but
soon pierce the latter and run between these
two planes of intercostal muscles as far as the
middle of the rib. They then enter the sub-
Figuhe 2. Diagram oj the Course and Branches of a Typi-
cal Intercostal Nerved^ (Reproduced by permission
oj the publisher.)
The Journal of the Maine Medical Association
stance of the Intercostalis interni and, run-
ning amidst their fibres as far as the costal
cartilages, they gain the inner surface of the
muscles and lie between them and the pleura.
hTear the sternum, they cross in front of the
internal mammary artery and the Transverus
thoracis muscle, pierce the Intercostales in-
terni, the anterior intercostal membranes,
and Pectoralis major, and supply the integu-
ment of the front of the thorax over the
mamma, forming the anterior cutaneous
branches of the thorax.
“Each nerve is connected with the adjoin-
ing ganglion of the sympathetic trunk by a
gray and white ramus communicans.”
Thus it is seen that the intercostal nerve
lies very superficially on the inner surface of
the anterior end of the rib and the rib carti-
lage, so that when the anterior end of the an-
terior rib cartilage below becomes detached
and deformed and slips up under the anterior
rib cartilage above, there is a strong likeli-
hood of nerve irritation. This probability is
emphasized by the fact that in every case re-
ported, when the deformed cartilage is re-
moved and clearance of the rib-end estab-
lished, the pain disappears immediately and
permanently.
There is a wide distribution of nerves in-
volved, namely, the intercostals, connected
with the brachial and lumbar plexuses and
the sympathetic system. By way of the sym-
pathetics, the intercostal nerves are in direct
communication with the cardiac, the solar or
epigastric, and the hypogastric plexuses,
which, in turn, have branches to the viscera.
As cited by Cyriax,® and later by Davies-
Colley,^ the close association of the intercos-
tal nerves with the sympathetic system
accounts for frequent pain symptoms that
suggest intra-abdominal or intra-thoracic le-
sions, and has led to mistaken diagnosis.
Whether the synovial membranes of the
interchondral joints that are involved in the
slipping rib cartilage deformity contribute in
any way to the pain manifested should be
considered. So far, the pathological examina-
tions of specimens obtained from these opera-
tions have revealed nothing of especial
interest.
Deformity of the loosened rib cartilage, to
produce the click and the accompanying pain,
develops secondarily, and hence may not be
93
Nineteen Hundred and Forty- two — May
recognized as coming from the original in-
jury. With this in mind, I believe a carefully
taken history will, in all cases, show the origi-
nal cause to be direct or indirect trauma.
Diagnosis
Diagnosis of slipping rib cartilage is made
from the history of pain in the chest or ab-
domen, usually, in part at least, at or near the
rib border, and over a period of time. Some
of the patients complain of a slipping sensa-
tion or of something giving away at the rib
borders, associated with pain. Others speak
of bunches on, or of soreness of, the rib bor-
ders. By digital examination with the pa-
tient in supine position and the knees flexed,
an area of tenderness at the rib border is
noted, especially when the examiner’s Angers
are well under the rib border and pressing
outward. At the same time the abnormally
movable rib cartilaae, with its associated
click and pain, may be demonstrated. The
slipping rib cartilage is easy to demonstrate
in some cases and difficult in others so that,
given a suggestive history, and an area of ten-
derness at the rib border, a tentative diagno-
sis can be established, and repeated examina-
tions, or examination under anesthesia, made
to confirm it. This is especially true of the
acute case where muscle spasm is likely to
prevent satisfactory local examination.
The intensity of pain complained of is fre-
quently well away from the rib border in the
anterior chest wall, in the breasts, in the
heart region, in the shoulder blades, or in the
back and the abdomen, but usually there is
an associated general soreness of the ribs and
an acute localized tenderness at the rib bor-
der. It is important to rule out other possible
causes or factors, especially when the pain
symptoms involve the abdomen and raise the
question of an intra-abdominal lesion, and
here X-ray examination is of gveat assistance.
The same is true of the chest when a question
of fractured rib is considered, either as a
cause or contributory factor of pain.
Limitation of chest expansion as demon-
strated by measurement is a suggestive diag-
nostic feature.
Positions of carriage and action of the
body and limbs are noteworthy. Some pa-
tients are bent forward and to the affected
side; some cannot raise their arms without
causing pain. Some have pain in bending
forward and on rising from a forwardly bent
position, so that they accomplish this act by
crouching and rising with the back straight.
It is of the greatest importance in diag-
nosis to have this syndrome in mind and also
to have a clear understanding of its develop-
ment.
Treatment
Cyriax^ treated his patients conservatively,
but other cases reported have been treated
mainly by excision of the loosened cartilage.
This has usually resulted in immediate and
permanent relief of symptoms.
Personally, I have treated the acute con-
dition conservatively by adhesive strapping.
Later, in the course of one to three months,
or longer, if the symptoms persist, and with
sufficient severity, I advise operation, ex-
cision of the loosened cartilage.
Some of my cases have, in part at least,
recovered under conservative treatment.
Some of them have declined operation, pre-
ferring to tolerate the pain, or are still
considering operation. Those patients, twenty-
two in number, whose symptoms have con-
tinued and who have submitted to operation,
were treated by excision of the rib cartilage
or cartilages involved, with excellent and
often dramatic results.
Operation
The incision is made in the direction of
the slope of the ribs, three fingerbreadths
above the umbilicus and centered at the an-
terior-axillary line : or starting at a point one
fingerbreadth anteriorly and above the tip of
the eleventh rib cartilage (which can easily
be felt) the incision is made in the direction
of the slope of the ribs to the midaxillary
line. Having exposed the muscles, the opera-
tor’s fingers are hooked under the rib border,
and an examination made of the tenth, ninth,
and eighth rib cartilages, identifying the car-
tilage or cartilages involved. Supporting the
loosened cartilage with the fingers, the mus-
cles are separated down to the cartilage which
is to be removed and back to its articulation
with the rib. After pushing the anterior mus-
cle attachments away, disarticulation is per-
94
The Journal of the Maine Medical Association
fibers.
Fio. 307. — Tho TranavcrHUH ulniomini:*. Ttcclu.<» nb'luniini:*. an<l P.\ roiiinlali.'‘.
The arrow indicates the line of incision for re-
moval of the anterior rib cartilages as they per-
tain to The Slipping Rib Cartilage Syndrome.
Owing to the looseness of the skin this one in-
cision makes accessible all three cartilages, namely
the eighth, ninth and tenth.
formed, using a scalpel. The disarticulated
end of the cartilage is grasped in a double
hook, the muscle attachments, laterally and
beneath, are dissected off and the cartilage re-
moved. A further examination is then made
of the adjacent cartilages for any abnormal
motion, or deformity. If found, these carti-
lages should also be removed. If not found,
the incision is closed. Beginning at a point
between the end of the operated rib and the
rib above, a suture of plain catgut is taken
through the intercostal muscles. To this
point the adjacent intercostal muscles, pre-
viously detached from the cartilage, are
drawn in for protection. Continuing with
the same suture, the external muscle rent is
brought together and the skin incision closed.
Convalescence
Convalescence is usually uneventful. Tem-
porary bowel and urinary inaction may oc-
cur as the operation involves muscles that
assist in these expulsive acts. The patient is
usually immediately relieved of the ‘hid
pain” and leaves the hospital in from three
to ten days. It is important to discriminate
between the “old pain” and the pains that
patients sometimes have following this, or
any other type of operation ; hence the value
of a carefully taken preliminary history.
Otherwise the immediate operative results
may be wrongly interpreted.
Analysis of Opeeated Cases
Of 37 patients operated upon, 8 in the
literature prior to 1938, 8 by personal com-
munication and 21 of my own, the ages
ranged from six to fifty-seven years ; the con-
dition occurred on the left in 14 cases, on the
right in 13 cases, and bilaterally in 10 cases.
One rib was involved in 21 cases, 2 ribs in
11 cases, 3 ribs in 1 case and 4 ribs in 4 cases.
There was an area of tenderness at the site
of the lesion in all cases. There was a wide
variation in the character of pain. In some
cases it was dull, in others sharp, especially
on manipulation of the cartilage ; in still
others it was gripping or pulling. In some
cases the pain was so modified that it was
hardly recognized as such by the patients un-
til questioned, and they frequently did not
realize their handicap until they had been re-
lieved of the annoyance.
Pain was constant in some cases ; in some
it occurred with different positions of the
body or after certain types of muscle pull.
Instances occurred where remission of symp-
toms was brought about by rest from work or
from forced rest in bed, occasioned b_y illness.
Following excision of the offending carti-
lage or cartilages, relief of symptoms was ob-
tained, permanent and usually immediate.
There was no mortality.
Case Reports
Case 1. M. I., a 45-year-old mill operative,
was first seen at my ofiice on July 10, 1933.
He stated that in April, 1933, while putting
a belt on a pulley, his overalls were caught by
the pulley belt and he was lifted into the air.
He fell on the floor, cried out, and was not
able to arise. He immediately felt a sharp
pain in the hypochondriac region and along
the rib border. The pain was sharp, severe,
and had continued since then, off and on, be-
95
Nineteen Hundred and Forty-two — May
ing worse on exertion. Directly after the
accident, he was carried from the scene by
another employee and was attended by a
physician. The following month he was ex-
amined by three consultants but no definite
diagnosis was made.
Physical examination showed his general
condition to be excellent. At the right rib
border there was a definite point of tender-
ness. The anterior end of the anterior carti-
lage of the ninth right rib was found to be
abnormally loosened and deformed — curled
up under the rib cartilage above. On manipu-
lation, it could be brought out over the rib
border, causing pain and a click that could
be felt and heard. The diagnosis (then) was
fracture of the ninth right anterior rib carti-
lage with deformity.
On July 16, 1933, at the Elliot Hospital,
Manchester, jSTew Hampshire, an operation
was performed. The anterior end of the an-
terior cartilage of the ninth right rib was
found to be abnormally loosened and curled
up under the rib cartilage above. On manipu-
lation, it came out over the rib border with a
click. The loosened, deformed cartilage was
excised.
The wound healed, but the patient was
not entirely relieved. Physical examination
showed an abnormal loosening and deformity
of the anterior end of the anterior cartilage
of the eighth right rib.
On July 20, 1933, a second operation was
performed, at which time the loosening and
deformity of the eighth right anterior rib
cartilage was demonstrated, and the cartilage
was removed. The patient made an unevent-
ful recovery and on August 11, 1933, was
discharged well.
On April 24, 1939, six years later, the pa-
tient reported that he was in good health. He
could not work at all before the operation but
since then he had done all kinds of heavy
work, including pick and shovel work, cutting
lumber, handling junk and so forth. Physi-
cal examination showed the ends of the eighth
and ninth right ribs to be smooth and free
and not sensitive.
Case 2. P. H., a 30-year-old housewife,
was first seen at my office on September 11,
1939, at the request of Dr. F. IST. Rogers of
Manchester. The patient stated that she had
given birth to six children, each labor being
difficult. Since the birth of the last child,
sixteen months previously, she had suffered
pain in the right upper abdominal quadrant
and rib border. This pain was aggravated by
deep breathing and by certain movements of
the body. These symptoms had been inter-
preted as gall-bladder disease, for which she
had been expectantly treated.
Physical examination showed the patient’s
general condition to be good. There was a
definite point of tenderness at the right rib
border. At the ninth interchondral articula-
tion the anterior end of the ninth right an-
terior rib cartilage was found to be abnor-
mally loosened and deformed — curled up
under the rib cartilage above. On manipula-
tion, it could be brought out over the rib
cartilage above, producing a click and a se-
vere pain. The diagnosis was slipping rib
cartilage of the ninth right rib. The type of
force to produce the injury was indirect,
from chest stabilization and abdominal com-
pression in the expulsive act of childbirth.
On September 14, 1939, at the Elliot Hos-
pital, Manchester, an operation was per-
formed. The abnormally loosened and de-
formed ninth right anterior rib cartilage,
with its associated click on manipulation, was
demonstrated and excised. That evening the
|)atient remarked that the old pain at her
right rib border had gone. She made an un-
eventful recovery and was discharged from
the hospital in four days.
On October 24, 1939, the patient reported
that there had been no recurrence of pain in
her right side, that she was in good health
and doing her usual work. Examination re-
vealed no sensitiveness of the right border
and no abnormal motion.
Case 3. B. T., a 40-year-old housewife, —
a patient of mine for many years- — was first
seen for this complaint at my office on Janu-
ary 28, 1936. She stated that in Hovember,
1935, she had fallen on the stairs and hurt
her chest. She complained of pain in the
chest, shortness of breath, and said that her
heart beat fast. Her past and family liistories
were negative.
Physical examination showed the patient’s
general condition, including the heart and
lungs, to be normal. The abdomen was rather
96
full and thick, and there was some apparent
tenderness in the upper abdomen. The blood
pressure was 120 systolic, 80 diastolic. The
urine was straw color, acid in reaction, spe-
cific gravity 1020, albumen 0, sugar 0. The
feces were negative for blood.
Subsequently, a tentative diag-nosis of pep-
tic ulcer or gall-bladder disease was made.
On March 5, 1936, at the Elliot Hospital,
an X-ray examination was reported by Dr.
A. S. Merrill as follows : “Graham Test
(oral) shows a normally filled gall-bladder
which contracts and empties well after fat
food. Xo shadows are seen suggestive of
stones.’’
In June, 1937, the patient was examined
at the Massachusetts Memorial Hospital,
with the following X-ray report: “June 14,
1937, Gastrointestinal tract: Xo pathology
seen. June 24, 1937, Graham Test (double
oral) Good concentration of dye with good
contraction of the gall-bladder. Incomplete
emptying of the vesicle at 7 hours. Gall-
bladder is probably normal with delayed
emptying time.”
On June 1, 1939, the patient was still
complaining of pain near the waistline. She
remarked: “It is my ribs. I have said all
the time that it is my ribs,” and so a careful
examination of the rib borders was made. It
revealed that the anterior ends of the ninth
and tenth anterior rib cartilages on the right,
and the tenth on the left, were abnormally
loosened and deformed — curled up under the
rib cartilage above, and, on manipulation,
they could be brought out over the rib borders
with an audible click and an associated pain.
The diagnosis was slipping rib cartilage of
the ninth and tenth right, and the tenth left
ribs. The type of force to produce this injury
was direct, received at the time the patient
fell on the stairs. Operation was advised.
On February 6, 1940, the patient reported
that her rib condition had grown worse, that
she was suffering and could not work. She
was anxious to be operated upon.
On March 16, 1940, at the Elliot Hospital,
Manchester, an operation was performed, at
which time the anterior ends of the ninth and
tenth anterior rib cartilages on the right, and
the tenth on the left, were found to be ab-
normally loosened and deformed — curled up
under the rib cartilages above, and, on manip-
The Journal of the Maine Medical Association
ulation, they could be brought out over the
rib borders, producing an audible click. The
abnormally loosened and deformed anterior
rib cartilages were excised. Convalescence
was slow in this case. The patient was dis-
charged from the hospital on the thirteenth
day, relieved of her pain, but it was nearly
three months before she felt well disposed.
Since then she has been in good health.
Case 4. A. D., a 25-year-old W. P. A.
worker, was first seen at my office on Xovem-
ber 12, 1940. He stated that in June, 1938,
at an outing, while attempting to dive from a
tree, he fell backward, striking in a hyper-
extended position. X-ray examination, at the
Xotre Dame Hospital, Manchester, showed a
fracture of the first lumbar vertebra without
deformity, for which he was treated by plas-
ter cast with good recovery.
At the time of the accident, and afterward,
the patient suffered pain at the rib borders
and in the lower anterior chest, particularly
on raising his arms, on deep breathing and
on forward bending. The pain was constant
at first, but later he was fairly comfortable
while in repose.
Physical examination showed the patient’s
general condition to be good. There was a
localized area of tenderness at the rib mar-
gins, and the anterior end of the tenth an-
terior rib cartilage on either side was found
to be abnormally loosened and deformed —
curled up under the rib cartilage above. On
manipulation, they could be brought out over
the rib borders, producing a click and an
acute pain. The diagnosis was slipping rib
cartilage of the tenth rib bilaterally. The
type of force to produce the injury was in-
direct, from sudden hyperextension of the
spine at the time of the accident.
On Xovember 15, 1940, an X-ray examina-
tion of the spine at the Elliot Hospital,
“showed no evidence of pathology.”
On Xovember 29, 1940, at the Elliot Hos-
pital, an operation was performed. The ab-
normally loosened and deformed tenth an-
terior rib cartilages were demonstrated, and
excised. The eleventh rib and cartilage on
either side were found to be abnormally long.
The eleventh anterior rib cartilages were re-
moved for symmetry in relation to the an-
terior ends of the tenth ribs. For a few davs
97
Nineteen Hundred and Forty-two — May
following- operation, the patient had consider-
able difficulty in bowel evacuation and urina-
tion, obviously due to muscle pull on the rib
borders in stabilization of the chest and in
abdominal compression during those expul-
sive acts. However, his rib border pains were
relieved and he made a good recovery. He
was discharged from the hospital on Decem-
ber 12, 1940, and has remained well.
Case 5. 0. M., a 47-year-old housewife,
was hrst seen at my office on March 1, 1941.
She stated that in December, 1940, she fell
on her back with her foot under her. At that
time she felt a sharp pain at her rib borders,
especially on the right side, and she could
‘‘hardly breathe.” The pain on the right side
continued, and later, pain developed on the
left side. She had been continuously inca-
pacitated. While lying down, she was fairly
comfortable ; but on standing, on walking
about, on raising her arms, or on deep breath-
ing, she felt pain at the rib borders, especially
on the right side. She had consulted physi-
cians and had been thoroughly examined by
X-ray, but no satisfactory diagnosis resulted,
and the patient formed the opinion that she
had a cancer.
Physical examination showed her general
condition to be fair. At the rib borders, the
anterior end of the tenth anterior rib carti-
lage on either side was found to be abnor-
mally loosened and deformed — curled up
under the rib cartilage above. On manipula-
tion, they could be brought out over the rib
borders, producing a pain and a click. The
diagnosis was slipping rib cartilage of the
tenth rib bilaterally. The type of force to
produce the injury was indirect, from sudden
hyperextension of the spine at the time of the
fall.
On March 12, 1941, at the Sacred Heart
Hospital, Manchester, an operation was per-
formed. The abnormally loosened and de-
formed tenth anterior rib cartilage on either
side (with an associated click, on manipula-
tion, over the rib margins) was demonstrated,
and the loosened cartilages were removed.
The rib border pain almost immediately
disappeared, but the patient was a little slow
in recovering from the operation. She left the
hospital on the twelfth day, and gradually re-
gained her normal composure and strength.
There has been no return of pain.
Case 6. H. M., a 17-year-old girl, was first
seen at my office on July 3, 1941. She stated
that six years previously, at ga-ammar school,
she tripped and fell down stairs, striking her
right side. She had some pain, but thought
little of it until about one year later when the
pain became worse. She consulted a physi-
cian, and an examination (including X-ray
examination) was made; but no lesion was
found. The symptoms continued, and in Sep-
tember, 1939, further X-ray examinations,
including the hips, the pelvis, and the spine,
were made; but no abnormality was noted.
Pain and discomfort in the rib borders con-
tinued. In April, 1941, she began to work in
a worsted mill at which occupation she stood
on her feet and moved her arms back and
forth on a level. After working ten Aveeks she
Avas unable to continue.
Her complaint was pain at the rib margins,
especially on the right side, when walking or
standing, and on bending or tAvisting of the
body. The pain began at the rib borders and
radiated to the abdomen and the back. She
AA"as incapacitated.
Physical examination showed the patient’s
general condition to be good. At the left rib
border there Avas a localized area of tender-
ness, the anterior end of the tenth anterior
rib cartilage Avas found to be abnormally
loosened and deformed — curled up under the
rib cartilage above, and on manipulation it
could be brought out over the rib border, pro-
ducing an audible click and a definite pain.
On the right side, the tenderness at the rib
border Avas more marked, and, owing to mus-
cle spasm, motion of the anterior rib carti-
lages could not be satisfactorily determined or
estimated. However, the anterior end of the
tenth anterior rib cartilage could be felt
curled up under the rib border. The diag-
nosis Avas slipping rib cartilage of the ninth
and tenth right, and the tenth left ribs. The
type of force to produce the lesions was direct
on the right side and indirect on the left side,
from the bloAv and sudden flexion of the body
at the time of the fall on the stairs.
On July 11, 1941, at the Elliot Hospital,
Manchester, an operation was performed.
98
The Journal of the Maine Medical Association
The abnormally loosened and deformed tenth
left anterior rib cartilage, with its associated
click as it passed out over the rib border on
manipulation, was demonstrated and the car-
tilage was excised. On the right side the an-
terior end of the eleventh anterior rib carti-
lage had apparently been fractured ; the
distal fragment was drawn upward at right
angles and rested underneath the tenth an-
terior rib cartilage. The tenth anterior rib
cartilage was abnormally loosened and de-
formed— curled up under the rib cartilage
above — and on manipulation it could be
brought out over the rib border, producing an
audible click. The ninth anterior rib carti-
lage at its proximal end had a cartilagenous
union with the eighth anterior rib cartilage,
but its distal end was loose. The fractured
end of the eleventh right anterior rib carti-
lage, and the anterior cartilages of the tenth
and ninth right ribs were removed. Two days
later, the patient stated definitely that her old
pain was gone and that she felt well. Four
days after the operation she was discharged
from the hospital and has remained in excel-
lent health.
Summary
1. Slipping rib cartilage is a loosening
deformity involving the anterior ends of the
anterior cartilages of the vertebrochondral
ribs, namely, the eighth, ninth, and tenth on
either side. It is not concerned with the osteo-
chondral articulations.
It begins with a loosening of the fibrous
hammock-like attachments of the anterior end
of the anterior rib cartilage which may occur
at once, or over a period of time, and is fol-
lowed by a deformity- — a curling upward of
the cartilage-end so that it rises to the insido
of the rib cartilage above and comes in close
relation to the intercostal nerve, the seat of
the pain.
It is always of traumatic origin, either di-
rect or indirect, more often the latter ; occur-
ring singly, and as multiple and bilateral
lesions.
Age or sex are of no consideration.
2. The cartilage deformity usually de-
velops over a period of time subsequent to the
loosening. The patient frequently does not
associate the injury with the complaint, and
the cause is not recognized; this is particu-
larly true of indirect injury.
Aside from direct injury, this loosening
may occur from indirect force in many ways,
due to the several muscle attachments, and
the different directions and degree of muscle
pull.
There is a wide distribution of nerves in-
volved, namely, the intercostals connected
with the brachial and lumbar plexuses and
the sympathetic system. By way of the sym-
pathetics, the intercostal nerves are in direct
communication with the cardiac, the epigas-
tric, and the hypogastric plexuses which, in
turn, have branches to the viscera. Thus the
pain manifestations cover a wide field.
The intensity of pain complained of is fre-
quently well away from the rib border — in
the anterior chest wall, in the breast region,
in the shoulder blades, in the back, in the
abdomen, and so forth ; but usually there is
an associated general soreness of the ‘hlbs”
(so spoken of by the patient) and a localized
area of tenderness at the rib border.
3. Diagnosis is made from the history of
pain in the chest or abdomen over a period
of time. Usually the pain is in the anterior
chest at, or near, the rib borders. There is a
localized area of pain at the rib margin, the
site of the lesion. By digital manipulation,
with the patient in supine position and the
knees flexed, the abnormally loosened and de-
formed cartilage caii be brought out over the
rib border with a click and a pain that is
diagnostic. X-ray examination is of assist-
ance in ruling out deeper lesions of the chest
and the al>domen.
4. The pain of slipping rib cartilage is
not like other pains. It is usually a dull ache,
and is often tolerated for years, even a life-
time. Some patients scarcely realize that they
are impaired until operation is performed
and their annoyance is taken away. Others
suffer severely, and are acutely and com-
pletely incapacitated.
There are many cases of obscure pain asso-
ciated with the chest and abdomen which may
have as their origin the slipping rib cartilage.
Therefore, examination of the rib borders
should be made routinely.
Continued on page 101
Nineteen Hundred and Forty-two — May
99
Pulmonary Suppuration Secondary to Esophageal Diverticulum"^
By Frederick T. Hied, M. D., The Thayer Hospital, Waterville, Maine
Jackson states that patients with esopha-
geal diverticula may have pulmonary symp-
toms from overflow of food or secretions. The
pulsion diverticulum of the upper esophagns
is formed by the herniation of the mucosa
and submucosa througli the weak portion of
the posterior wall where the musculature is
absent. The resulting pouch gTadually in-
creases in size and gravitates do^\mward from
the weight of the swallowed food which ac-
cumulates in the poucli and only overflows
into the esophagus. The lumen of the esoph-
agus becomes increasingly narrowed by the
diverticulum pulling down on tlie sling fibers
of the cricopharyngeus. This lumen to the
subdiverticular esophagus is always situated
high on the anterior wall just behind the
larynx. Sometimes it is almost impossible to
identify this on endoscopic examination.
With a tightly narrowed lumen resulting
from a large pouch conditions would seem
almost ideal for a spill over into the respira-
tory tract. Previously unrecoguized esopha-
geal diverticula would seem to be the direct
causes of pulmonary infection in the follow-
ing two cases :
Case Ho. 1. Mr. R. L., age 34. Seen in
consultation at the Central Maine General
Hospital, Lewiston. This patient had had
difiiculty in swallowing for several months.
Four weeks prior to admission he had choked
while trying to raise accumulated secretions
from his throat. Shortly after this he had
sharp pain in his right lower chest and de-
velojied a cough, loss of weight and strength,
and drenching night sweats. Cough was pro-
ductive only in the morning. Four days prior
to admission he had raised some blood.
He carried a slight temperature averaging
100, and examination of the lungs revealed
a few rales heard posteriorly at the inner
margin of the right scapula, at the end of
deep inspiration. R. B. C., 4,670,000,
#1 — Case 1. Roentgenogram showing esophageal ^2 — Case 1. Roentgenogi’am showing pulmonary
diverticulum. abscess.
* Read at the meeting of the N. E. Oto-Laryngological Society, Boston, Massachusetts, November 19,
1941.
100
The Journal of the Maine Medical Association
W. B. C., 16,300, Polymorphonuclears, 84%.
Kahn negative. Blood sedimentation rate, 26
mm. Sputum examination showed gram neg-
ative diplococci in sarcenae formation, gram
positive cocci in chains.
Roentgenological examination showed an
area of increased density posteriorly in the
right lower lobe of the lung, consistent with
a lung abscess. X-ray of the esophagus
showed the hypopharynx to end in a blind
pouch. Prom the anterior wall of this area,
almost 2.5 cm. above its lower portion, the
barium continued, into the esophagus. This
was consistent with esophageal diverticulum.
Bronchoscopic examination showed puru-
lent secretion coming from a secondary dorsal
branch in the right lower lobe bronchus.
Esoj:)hagoscopy revealed a moderate sized but
shallow diverticulum at tlie level of the crico-
pharyngeus. The narrow lumen of the suh-
diverticular esophagais was found anteriorly.
Below this the esophagus was normal. Just
above the diverticulum there was a crescentic
weh on the left side, which was evulsed.
As no improvement followed conservative
treatment, external operation with insertion
of drainage tul)e into the abscess cavity was
performed by Dr. William J. Cox. Follow-
ing this there was a gradual uneventful con-
9^3— Case 2. Roentgenogram showing very large
esophageal diverticulum.
valescence. There has been no recurrence of
cough or evidence of activity in the chest.
The patient reports he is swallowing with
much less difficulty although of course the
diverticulum is still present.
Case ISTo. 2. Miss C. S., age 66, a thin,
emaciated woman suffering from a crippling-
multiple arthritis. Seen in consultation with
Dr. J. 0. Piper at the Thayer Hospital. She
had had increasing difficulty in swallowing for
44 years. For some time she had been carry-
ing a temperature of 100-101. She had been
in another hospital for a number of months,
where a diagTiosis of tuberculosis had been
made from the lung condition. Xo attention
had been paid to the esophageal symptoms.
Dr. Piper had been unable to concur in this
diagnosis of tuberculosis hut strongly sus-
pected esophageal diverticulum from her his-
tory. She had a productive cough and rales
were always present in both lungs. Sputum
was never positive for tubercular bacilli. For
many months she had been taking mineral
oil routinely.
Roentgenological examination showed a
coarse infiltration throughout both lungs.
There was a large esophageal pouch 4.5 cm.
broad by 5.5 cm. deep, extending to the aortic
^4 — Case 2. Roentgenogram showing diffuse
pneumonitis probably secondary to aspiration
of mineral oil.
101
Nineteen Hundred and Forty-two — May
arch. Barium was seen to overflow from the
top of the pouch to the left and to pass down
anteriorly to fill a normal appearing esoph-
agus. At times barium was seen to spill over
into the larynx.
Endoscopic examination, under local an-
aesthesia, revealed a very large diverticulum.
The lumen of the subdiverticular esophagus
could not he identified. There was consider-
able secrefion in both main bronchi and some
barium mixture was recovered from the right
bronchus.
The patient was referred to T)r. Frank
L alley, who performed a two-stage operation
for the removal of the diverticulum. She
made a satisfactory convalescence, and is now
taking food perfectly well. She has gained
weight but Roentgenological examination
shows little change in her lung condition.
Obviously she has had an aspiration pneumo-
nitis from the diverticulum. It is interesting
to speculate upon the part played by aspi-
rated mineral oil in producing a lipoid pneu-
monitis and the prognosis of this latter con-
dition. In all probability these lesions due to
aspirated lipoid will be permanent.
SUMMAKY
Two cases of pulmonary infection second-
ary to overflow from esophageal diverticula
are reported. One was a case of frank lung
abscess, relieved by operation, in which the
esophageal sym2:)toms seem improved, at least
for the present. The second case was one of
pneumonitis, with probable lipoid aspiration,
in which operation cured the diverticulum
but with little possible change in the lung
condition.
The Slipping Rib Cartilage Syndrome— Continued from page 98
5. Information relative to the slipping
rib cartilage syndrome should be generally
disseminated.
G. Treatment : The acute condition should
be treated conservatively. Later, in the
course of from one to three months, if the
symptoms persist with sufficient severity, ex-
cision of the loosened, deformed cartilage or
cartilages involved should be advised. Opera-
tion results usually in immediate and perma-
nent relief of symptoms. There has been no
mortality.
Refeeekces
1. Holmes, John F.; A Study of the Slipping-rib-
cartilage Syndrome. New England Journal of
Medicine, 224:928-932, 1941.
2. Holmes, John F.: Slipping rib cartilage with
report of cases. American Journal of Surgery,
54:326-338, 1941.
3. Cyriax, E. F. : On various conditions that may
simulate the referred pains of visceral disease,
and a consideration of these from the point of
vieio of cause and effect. The Practitioner,
102:314-322, 1919.
4. Davies-Colley, R.: Slipping rib. Brit. M. J.,
1:432, 1922.
5. Poynton, F. J.: Memoranda. Brit. M. J., 1:
516, 1922.
6. Soltau, H. V. K. : Memoranda. Brit. M. J., 1:
516, 1922.
7. Marshall, C. J. : Memoranda. Brit. M. J., 1:
516, 1922.
8. Mahon, R. B. : Memoranda. Brit. M. J., 1:
602, 1922.
9. Russell, E. N.: Memoranda. Brit. M. J., 1:
664, 1924.
10. Bisgard, J. D.: Slipinng ribs: report of case.
J. A. M. A., 97:23, 1931.
11. Darby, J. A.: Slipping ribs: report of case.
Northwest Medicine, 30:471, 1931.
12. Gray, H.: Anatomy: Descriptive and applied.
Twenty-third edition. 1,381 pp. Philadelphia
and New York: Lea and Febiger, 1936. pp.
295, 934 and 935.
13. Lilienthal, H. : Thoracic Surgery: The surgi-
cal treatment of thoracic disease. Vol. 1, 600
pp. Philadelphia and London: W. B. Saunders
Co., 1925. P. 549.
14. Ballon and Spector: From the department of
Surgery of the Jewish General Hospital, Mon-
treal. Canadian Medical Association Journal,
1938-39. Pp. 355-56-57-68.
102
The Journal of the Maine Medical Association
Editorial
An Opportunity to Serve
Tlie ©iiormitj of the effort, sacrifice and
demands to be made, that the American Way
of Life he continued, must he apparent to any
one who enjoys the ability to think. We must
grasp the significance of what we must do in
an effort, well termed all out, to preserve onr
very existence on earth. The military cabal
of Japan and Germany appreciate this fact
and know beyond question it is them or ns.
If success is theirs the price of defeat cannot
be measured in terms of anything but eco-
nomic and social slavery of the most hideous
type. Any doubt or confusion on this point
poorly becomes a nation occupying the posi-
tion of the United States.
Perhaps no other category of professional
men occupies the position that medicine does
today. The scientific achievements of medi-
cine in the United States, the development of
our vast and envied hospital systems are the
end results of conditions and principles that
have made them possible. They must and
will be preserved and that means we must
and will win this war. We would be a pitiful
people indeed, Avith all our resources; finan-
cial, technical and scientific, if any other idea
could be entertained. Willing or not, the
])eoples of Germany and Japan are behind
their Avar-lords in an attempt to enslaA^e two
thousand million human beings who inhabit
this earth ; can we as a nation do less than
accept the challenge that means our A^ery
lives ?
War today is a far, far different affair
than that of World War I. It is a war de-
manding the highest of technical and special
skills and as a profession Ave are fortunate
that American Medicine is in the position to
offer services that bring with them a justified
warrant they are the best obtainable. Six
thousand, one hundred physicians must be
supplied before the end of the present year
to provide adequate medical care for the Air
Force; two thousand, five hundred before
July 1st. What a sufficient and skilled Air
Force means Avas apparent to the military
and naval rulers of Japan and Germany
years ago and much of their present success
is due to that branch of their armed service.
Are Ave any less intelligent? The ISTavy will
need a total of 3,000 doctors when its enlist-
ment of 500,000 is reached; 16,000 new
physicians must be supplied before January,
1943. Civilian and industrial requirements,
plus other services, are not a whit less im-
portant, the medical personnel for which will
probably com© from the older gToups and men
handicapped by physical defects. It should
be obvious to all medical men in the induction
possibility that the criteria for deferment
from military services of physicians cannot
be the same as for laymen of the same age
having an equal number of dependents. A
doctor has the practical assurance of a com-
mission and his dependents can be supported
on an officer’s pay.
As far as known no other group of profes-
sional men has aA^ailable the assistance which
is afforded by the Procurement and Assign-
ment Agency. Established by Presidential
executive order tlie service is in a most en-
viable position to meet our rapidly increasing
needs and insure an irreducible minimum of
sacrifice and interruption of civilian needs,
but the service cannot engage to its full value
unless it has the utmost cooperation from the
profession. Thousands of physicians aaJio are
Tinder 45 years of age are, under the rules of
the Selective Service Act, liable for military
service and those not holding commissions are
liable to induction. The Jouenal has credible
information that induction will mean at least
three months’ service in the ranks before a
commission is possible. Recognizing the in-
justice and stupidity of wasting such skills as
medicine demands, the government, through
and by the Procurement and Assignment
Service, has afforded every physician the op-
porhinity Avhereby he will be certified for po-
sitions commensurate Avith his professional
training and experience as requisitions are
placed with the service requiring the assist-
Nineteen Hundred and Forty-two — May
ance of those whose good fortune it is that
they can bring so mnch needed help to their
country.
By means of this system, national in its
scope, medicine has been placed in a most
enviable position. The need was seen and es-
tablished, long before Pearl Harbor was a
fact, by the American Hedical Association
and the men who comprise the working per-
sonnel have been allocated a duty and respon-
sibility they will carry out with a due and
high regard for the obligation that is theirs.
It is a pity indeed that such a hideous thing
as this war is a matter of fact. Since it is,
peace and decency can return only when we
win.
Defense Savings
The Japanese onslaught on Pearl Harbor,
the Philippines, Malaya and Java, the Hazi
attacks on onr merchant ships have brought
America face to face with the reality of war
— war that encircles the globe. We know that
this is our war, one which demands all-out
effort in service, materials, machines and
money.
We as physicians and surgeons are well
aware of the importance of medical service
in the nation’s all-ont fight for freedom. We
have already shown onr willingness to serve
on foreign and home liattlefronts in the care
of both armed and civilian forces. This is
our professional job. But we must do even
more.
As Americans, we must help provide the
money to expand the war program to the
maximum of our resources. Tax dollars are
not enough. Loans to the Government from
banks do not make np the deficit. We as in-
dividuals must lend our dollars to the govern-
ment through the purchase of war securities
— The United States Savings Bonds.
The dollars invested in United States Sav-
ings Bonds buy planes, tanks, ships and guns,
and safety. The buying of these securities re-
duces our own purchasing power for material
goods and thereby serves as a check upon run-
away prices and inflation. For us as indi-
viduals, the securities represent savings
which gTow in value.
Series E Bonds are “People’s Bonds”
which can be purchased only by individuals.
The smallest costs $18.75 and pays $25.00 at
the end of 10 years — a 33Ui pei’ cent increase
in value. An E Bond may be redeemed by an
owner any time after sixty days from the
date of issue. Hence, we can draw upon these
financial reserves in case of need.
Series E Bonds are also appreciation
bonds, but these may be purchased by asso-
ciations and corporations as well as individ-
uals. The E Bonds are 12-year bonds which
])rovide a return equivalent to an annual in-
terest rate of 2.53 per cent. The smallest
costs $18.50 and pays $25.00 in 12 years;
the largest costs $7,400.00 and pays
$10,000.00 at maturity. Bonds of Series G
are sold at par in denominations from
$100.00 to $10,000.00, and these bonds pay
interest at the rate of 244 per cent throughout
their 12-3^ear maturity period.
Freedom Bonds, Victory Bonds — we must
buy and continue to buy these war securities.
We must put our dollars into the front line
battle in America’s fight for freedom.
104
The Journal of the Maine Medical Association
Necrology
Bertrand Francis Dunn, M. D„
1844-1942
At the time of his death, which occurred on
April 11, 1942, Doctor Dunn probably was the old-
est physician in the State of Maine, having been
born on January 9, 1844, in the town of Oxford,
one of eight children of James and Ruth Strout
Dunn. In his fourth year, the family moved to a
rocky farm on Pigeon Hill, Poland, where the
father eked out a livelihood for his hungry brood
by barter.
Also at the tender age of four, the Doctor in-
formed the writer, he decided to become a physi-
cian, a decision prompted wholly by his admira-
tion of his family doctor’s “horse and gig.’’
However, his father, ever mindful of the necessity
for providing his children with as good an educa-
tion as was possible, sent young Bertrand to High
School at Minot’s Corner and Lewiston Falls Acad-
emy, then to Kent’s Hill Seminary for two years,
and later, to Edward Little Institute at Auburn,
Maine.
When he was eighteen, he and six of his school-
mates enlisted in the 23rd Maine Volunteers and
served nine months in the Civil War. After re-
turning with the Regulars to Camp Lincoln at
Ligonia (South Portland), he and his chums were
sent by steamer to Jersey City and thence to Wash-
ington. His most vivid recollecton of the latter
place was that of marching up Pennsylvania Ave-
nue in mud over his ankles, following a drove of
hogs. Now followed a visit to Maryland where he
did picket duty on the banks of the Potomac, at
Camp Seneca, later at Alexandria, Virginia,
Harper’s Ferry and Maryland Heights. He de-
lighted to say, “all I ever shot at during the war
was a muskrat and I’m not sure that I killed him.”
Having been duly mustered out of the service in
1863, our young patriot sought some means of earn-
ing money with which to pursue his medical stud-
ies at Bowdoin. An opportunity presented itself at
Ricker Hill School where the superintendent
wanted a man for the winter term whom the boys
could not ride on a rail. Young Dunn accepted
this double-barrelled challenge with alacrity “and,”
he chuckled, “I missed the pleasure of one of those
rides.” From teaching, he went to the State School
for Boys at South Portland in charge of the Chair
Shop at thirty dollars a month.
His medical education really began in 1865,
when, as a student of the late Doctor Seth C.
Gordon, whose office was in the Morton Block near
the Preble House, he cared for the doctor’s office
for his tuition. That fall he “took a course of lec-
tures at Bowdoin and came home dead broke.”
But a job selling life insurance at fifty dollars a
month, plus another year’s teaching at West
Poland, plus a loan enabled him to complete his
medical education, and he received his medical de-
gree in 1868. Dr. Gordon gave him the use of one
of his offices on condition that he care for both.
This arrangement lasted four months, during
which time, Dunn stated, “I had two patients, an
Irishman and a Negro woman.”
In ’68, he “bought out” one Doctor John Kimball
of Harrison, and hung out his shingle in George
Pierce’s house in the village. Much to his dismay
and alarm, for he never had seen an obstetric case,
he was called first to attend a woman in confine-
ment. It always gave him pleasure to recount that
experience something after this fashion: “My rid-
ing gear was an old black pacer and a two-wheeled
gig. My first call was in the night, which was
very gratifying to me, as I had a dread of being
seen in that rig in the daytime. As this was my
first confinement case, I was rather excited and
had some trouble getting my clothes on right. I
put my vest on wrong side out. The worst was yet
to come, however, for when I went to harness my
horse, I got the breeching over the horse’s neck
and the breastplate under his tail. When I thought
I had everything right, I got into the gig only to
discover that the bits were not in the horse’s
mouth. But, once in order, T set out at a 2.40
clip,’ thinking of all the things that might happen
to my patient, of what I should do and say. Arriv-
ing at my destination, I entered the sitting-room
with fear and trembling, waiting until I should be
called to the sick room as I had been taught to do
by my instructors. Then came the dread moment,
when, in the presence of several wise old ladies of
the neighborhood, I had to examine my patient
and report progress. Hesitating, lest I should ex-
pose my ignorance, I was at a loss for words but
finally said, ‘H’m!! She effervesces well’.”
This case having terminated happily for all con-
cerned, our young doctor felt that his footing was
secure in Harrison and, accordingly, he married
Miss Clara Towle of Westbrook. They remained
two years in this town, when they learned that a
Doctor Kilgore was leaving Windham Hill.
Nineteen Hundred and Forty-two — May
105
Promptly the doctor and his bride packed their
belongings into barrels, loaded these on a canal
boat and set out for Windham Hill, there to re-
main until he established his final residence in
Portland in 1886.
From the day that he nailed up his sign on the
Hill, things medical were well Dunn in that neck
of the woods where his presence proved to be a
daily benediction to the community. Strong, sen-
sible, whole-souled, living a life of self denial and
tender sympathy, albeit at times a trifie declama-
tory, he came to know the “blessing which maketh
rich and addeth no sorrow.”
His hobby was pool which, until his ninetieth
year, he played daily at the Portland Club, rain or
shine. Then came supper, the evening paper, and
early to bed. Dunn was a dyed-in-the-wool Repub-
lican, having cast his first vote for Abraham
Lincoln.
He was throughout his long life in Portland a
member of the Williston Congregational Church
and he practised his religion in his daily living.
His rules for longevity were stated by him as
follows, — “Behave yourself. Lead a good, clean,
moral life. Eat regular meals. Go to bed at a rea-
sonable time, and, when you go to bed, go to sleep,
and sleep until morning. And don’t worry, for
worry, you know, is one of the ‘little foxes that
spoil the vines’.”
Thus, one by one, are severed the ties which bind
us to the medical past, a time when it took in-
domitable courage, and perseverance and physical
stamina and character like Dr. Dunn’s to endure.
Mrs. Dunn having passed away in 1928, the
doctor’s survivors include twenty-three nephews
and nieces, all of them college graduates.
E. W. Gehring.
County News and Notes
100% Paid-Up Membership
for 1942
Piscataquis County Medical Society
Franklin County Medical Society
Washington County Medical Society
Lincoln-Sagadahoc Medical Society
Hancock County Medical Society
Oxford County Medical Society
Penobscot County Medical Society
Knox County Medical Society
Aroostook County Medical Society
Waldo County Medical Society
Cumberland
The 164th meeting of the Cumberland County
Medical Association was held at the Lafayette
Hotel, Portland, Maine, on Friday, March 27, 1942,
at 6.30 P. M.
The meeting was called to order by Roland B.
Moore, M. D., President.
Distinguished guests present from the Maine
Medical Association, each of whom addressed the
meeting briefly, were: Carl H. Stevens, M. D.,
President-elect, Belfast; Stephen A. Cobh, M. D.,
Chairman of the Council, Sanford; and Currier C.
Weymouth, Chairman of the Scientific Committee,
Farmington.
The speaker of the evening was Gordon M. Mor-
rison, M. D., of Boston, who spoke on “Fractures.”
His paper was discussed by Drs. Milton S. Thomp-
son, Thomas A. Martin, and Henry W. Lamb.
James Patterson, M. D., was admitted to mem-
bership by transfer from the Westchester County
Society of New York.
The application of James B. Morrison, M. D., was
received and referred to the Council.
The meeting was preceded by a Clinic at the
Maine General Hospital at 5.00 P. M. The program
was as follows:
1. Subcapital Fracture of the Neck of Femur —
Thomas A. Martin, M. D.
2. Smith-Peterson Cup Arthroplasty — Henry W.
Lamb, M. D.
3. Difficulties in X-ray Diagnosis of Small Chip
Fractures — Jack Spencer, M. D.
4. Fracture of Spine Without Definite Localiz-
ing Symptoms — Langdon T. Thaxter, M. D.
5. Compound Comminuted Fractures of the
Lower Femur — Leo McDermott, M. D.
6. Traumatic Radiculitis Following Injury to
the Cervical Spine — H. Eugene Macdonald, M. D.
Respectfully submitted,
El'gexeE. O’Donnell, M. D.,
Secretary.
Portland Medical Club
The regular monthly meeting was held at the
Columbia Hotel, February 3, 1942, at 8.15 P. M.
There were thirty-six members and one guest
present.
Drs. Joseph G. Ham and Sidney R. Branson
were elected to membership.
The Club voted to change the place of meeting
to the Eastland Hotel.
Resolutions on the death of Doctor Charles B.
Sylvester were adopted.
The Scientific Program was presented by Dr.
Mortimer Warren and Dr. Joseph E. Porter. Dr.
Warren spoke on Anemias — Classification and
Treatment . Dr. Porter dealt with Transfusions of
Blood, Plasma, and Blood Substitutes. Reaction to
Transfusions, Administration of Blood Banks. Dr.
Warren introduced Dr. Preston Kyes who gave a
most interesting account of his personal acquaint-
ance with and his appraisal of Paul Ehrlich.
Following the meeting light refreshments were
enjoyed.
Respectfully submitted,
Alice Whittier,
Secretary.
106
The Journal of the Maine Medical Association
The regular monthly meeting was held at the
Eastland Hotel, March 3, 1942, at 8.15 P. M., with
Dr. F. J. Welch presiding. There were thirty mem-
bers present.
Dr. E. A. Greco presented the paper of the eve-
ning. In dealing with the subject Hypertension, he
defined hypertension, stressed the importance of
detecting it in the early stages, told the fate of
the hypertensive patient, and discussed treatment.
He called upon Dr. J. E. Porter for a discussion of
the pathology, and upon Dr. H. E. Macdonald to
speak of the surgical approach to the problem.
Following the meeting light refreshments were
enjoyed.
Respectfully submitted,
AxiCE WlIIT'nEK,
Secretary.
Kennebec
A meeting of the Kennebec County Medical As-
sociation was held at the Augusta General Hos-
pital, on Thursday, April 16, 1942.
Clinical Session at 5.00 P. M., which was pre-
sided over by L. Armand Guite, M. D., President:
1. Lung Abscess — P. E. Provost, M. D.
2. A Case of Fibroid of Uterus with Degenera-
tion of Fibroid — M. T. Shelton, M. D.
Brig. General John G. Towne, State Chairman of
the Procurement and Assignment Service gave a
very interesting and instructive talk on the Pro-
curement and Assignment of physicians for mili-
tary service.
Dinner at 6.00 P. M., which was followed by a
business meeting. Minutes of the last meeting
were read and approved.
Guests at the meeting included: P. L. B. Ebbett,
M. D., President of the Maine Medical Association,
and Carl H. Stevens, M. D., President-elect of the
Maine Medical Association. Dr. Ebbett spoke
briefly on matters pertaining to the State Associa-
tion especially from a military angle.
The speaker of the evening was Ethan Allen
Brown, M. D., of Boston, Mass., who is associated
with the Pratt Diagnostic Hospital. Dr. Brown
spoke on Alleryy. His talk was very interesting;
he outlined the different types of allergy and dis-
cussed treatment. This was followed by a general
discussion.
The meeting was unusually well attended, 50
members and guests being present.
Respectfully submitted,
Frederick R. Carter, M. D.,
Secretary.
Penobscot
The regular monthly meeting of the Penobscot
County Medical Association was held at the Ban-
gor House, Bangor, Maine, on Tuesday, March 17,
1942.
John S. Houlihan, M. D., resident of the Eastern
Maine General Hospital, was elected to member-
ship.
A very interesting symposium on Gall Bladder
and Stones in the Biliary Tract was presented by
the following:
Surgery (illustrated by motion pictures) — F. V.
Hussey, M. D., Providence, Rhode Island.
Anaesthesia — ^Myer Saklad, M. D., Providence,
Rhode Island.
X-ray Studies of the Biliary Tract — E. W. Ben-
jamin, M. D., Providence, Rhode Island.
There were fifty present.
Forrest B. Ames, M. D.,
Secretary.
York
A meeting of the York County Medical Society
was held at the Hillcroft Inn, York Harbor, Maine,
on Wednesday, April 8, 1942.
Following dinner the business meeting was
opened by Carl E. Richard, M. D., President.
Elected to membership were: J. Robert Down-
ing, M. D., Kennebunk; Marion K. Moulton, M. D.,
West Newfleld; John J. Murphy, M. D., Wells
Beach; and Robert D. Vachon, M. D., Sanford.
The next meeting will be held in Sanford with
Stephen A. Cobb, M. D., as Chairman.
The speakers of the evening were:
David E. Dolloff, M. D., Biddeford. Subject:
Civilian Defense.
Eugene H. Drake, Lieut. Comdr., M. C., U. S. N.
Subject: Medicine.
Rolf Lium, M. D., Portsmouth, N. H. Subject:
Surgery.
There were twenty-five members and guests
present.
Respectfully submitted,
C. W. Kinghorn, M. D.,
Secretary.
New Members
Cumberland
Janies Patterson, M. D., 614 Highland Avenue,
South Portland, Maine (by transfer from the West-
chester County Society, New York).
Penobscot
John S. Houlihan, M. D., Bangor, Maine.
York
J. Robert Downmg, M. D., Kennebunk, Maine.
Marion K. Moulton, M. D., West Newfleld, Maine.
John J. Murphy, M. D., Wells Beach, Maine.
Robert D. Vachon, M. D., Sanford, Maine.
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ments, etc. Guaranteed reliable potency.
Our products are laboratory controlled
Write for general price list.
Chemists to the Medical Profession.
THE ZEMMER COMPANY
Oakland Station, Pittsburgh, Pa. mas-42
Nineteen Hundred and Forty- two — May
107
Notices
Coming Meetings
National Medical Societies
American Medical Association
Olin West, M. D., 535 North Dearborn
Street, Chicago, Secretary.
Annual Meeting — Atlantic City, June 8-12,
1942.
State Medical Societies
Connecticut State Medicai Society
Creighton Barker, M. D., 258 Church
Street, New Haven, Secretary.
Annual Meeting — Middletown, June 3-4, 1942.
Maine Medical Association
Frederick R. Carter, M. D., 142 High
Street, Portland, Secretary.
Annual Meeting — Poland Spring, June 21-23,
1942.
Massachusetts Medical Society
Michael A. Tighe, M. D., 8 The Fenway,
Boston, Secretary.
Annual Meeting — Boston, May 26-27, 1942.
New Hampshire Medical Society
C. R. Metcalf, M. D., 5 South State Street,
Concord, Secretary.
Annual Meeting — Manchester, May 12-13, 1942.
Rhode Island Medical Society
W. P. Buffuin, M. D., 122 Waterman Street,
Providence, Secretary.
Annual Meeting — Providence, June 3-4, 1942,
Vermont State Medical Society
Benjamin F. Cook, M. D., 154 Bellevue
Avenue, Rutland, Secretary.
Annual Meeting — Bennington, October, 1942.
State of Maine
Board of Registration of Medicine
Adam P. Leighton, M. D., Portland, Secretary.
List of Physicians licensed on March 11, 1942.
Through Written Examination
David Davidson, M. D., Greenwood Mountain,
Maine.
Gisela Kaufer Davidson, M. D., Greenwood Moun-
tain, Maine.
James Canfield Fisher, M. D., Arlington, Ver-
mont.
Gerhard Hirschfeld, M. D., State Hospital, Ban-
gor, Maine.
Kenneth Abram LaTourette, M. D., 68 Perham
Street, Farmington, Maine.
Charles Louis Quaglieri, M. D., 3 Armstrong
Avenue, Jersey City, N. J.
Paul Edward Taylor, M. D., Rogers Road, Kit-
tery, Maine.
Through Reciprocity
Carl M. Haas, M. D., Beaver Dam, Kentucky.
Harry Kopfmann, M. D„ Deer Isle, Maine.
Armin Lichter, M. D., Wesley Hospital, Wichita,
Kansas.
Jay Kershner Osier, M. D., 156 State Street, Ban-
gor, Maine.
Thomas Dennie Pratt, M. D., Waterville, Maine.
David Shapiro, M. D., 5001-17th Avenue, Brook-
lyn, New York.
Dwight E. Wilson, M. D., 70 Howe Street, New
Haven, Connecticut.
Tumor Clinics
Bangor: Eastern Maine General Hospital
Thursday, 11.00 A. M.-12.00 M.
Director, Magnus F. Ridlon, M. D.
Lewiston: Central Maine General Hospital
Tuesday, 10.00 A. M.-12.00 M.
Director, E. G. Higgins, M. D.
St. Mai-y's General Hospital
Wednesday, 4.00 P. M.
Director, R. A. Beliveau, M. D.
Portland: Maine General Hospital
Thursday, 11.00 A. M.-12.00 M.
Director, Mortimer Warren, M. D.
Waterville: Sisters Hospital
1st & 3rd Thursdays, 10.00 A. M.
Director, B. 0. Goodrich, M. D.
Thayer Hospital
2nd & 4th Thursdays, 10.00 A. M.
Director, E. H. Risley, M. D.
Venereal Disease Clinics
For the information of physicians wishing to
refer cases of venereal disease for treatment, the
State Bureau of Health announces that such facili-
ties are available in the following locations:
Augusta, Bangor, Bath, Belfast, Biddeford, Bing-
ham, Calais, Danforth, Eastport, Ellsworth, Grand
Isle, Guilford, Houlton, Island Falls, Lewiston,
Millinocket, Old Town, Portland, Presque Isle,
Rockland, Rumford, Sanford, Waterville, Wilton,
Winthrop.
Any physician wishing to refer a case may
obtain the name of the clinic physician, in the
town where the patient is to receive treatment, on
request to the Director, State Bureau of Health,
Augusta, Maine,
Vice President of Upjohn Firm Dies
Malcolm Galbraith, vice president and director
of sales of the Upjohn Company, died Friday morn-
ing, April 10th, in Kansas City.
Mr. Galbraith was born in Bowmanville, Ontario,
Canada, October 23, 1876. He received his bachelor
pharmacy degree at Ontario College of Pharmacy
in 1898, entering the drug business in Ontario the
same year. He later became a naturalized citizen
of the United States. In 1909, he left the H. K.
Mulford Company, of Philadelphia, to join the Up-
john Company. In October, 1929, he was elected to
the board of directors and named director of sales.
He was made vice president of the company in
May, 1936.
108
The Journal of the Maine Medical Association
Book Reviews
Manual of Bandaging, Strapping and
Splinting”
By: Augustus Thorndike, Jr., M. D., F. A. C. S.,
Associate in Surgery, Harvard Medical
School; Surgeon to the Department of Hy-
giene, Harvard University.
Illustrated with 117 Engravings.
Published by Lea & Febiger, Philadelphia, 1941.
Price, $1.50.
This flexible cover manual is expected to supply
useful elementary information concerning the use
and application of bandages, strappings and splints
to the inexperienced medical student, the pupil
nurse and other lay persons who are called upon
to supply this service of medical or surgical after-
care.
“Necropsy — A Guide for Students of
Anatomic Pathology”
By: Bila Halpert, M. D., Assistant Professor of
Pathology and Bacteriology, Louisiana State
University School of Medicine, and Visiting
Pathologist, Charity Hospital of Louisiana
at New Orleans.
Published by The C. V. Mosby Company, St.
Louis, 1941. Price, $1.50.
This guide is based upon the principles of the
method employed by Anton Ghon. It considers
the topography and anatomy of the various organs
in detail and gives special attention to regiohal
lymph nodes and tributary blood vessels. The
workings of the method are illustrated by sample
necropsy records. The pocket-sized little volume
may prove to be of considerable value as a guide
for anyone who is occasionally called upon to
perform necropsies.
“From Cretin to Genius”
By: Dr. Serge Voronofif.
Published by Alliance Book Corporation, New
York, 1941. Price, $2.75.
“The man of genius is a creator.” . . . “Genius
is an inborn autonomous faculty, independent of
general mentality, and manifested by sudden in-
spiration,” . . . “Anatomically, genius is always
united to a particular structure, to a particular
organization of the brain.”
It could be very fortunate for mankind if this
and this alone were true. It is most unfortunate
for mankind that the creativeness of an anatomic-
ally determined, autonomously functioning brain
does not always create constructively. The read-
ers of this book will do well to be very grateful to
the author of this very interesting and illumina-
tive work for presenting only the benevolent ex-
amples of human genius and kindly forgetting to
mention any of the uncountable examples of the
malevolent varieties. He seems to feel that man-
kind at large does not treat genius well but if “a
being truly endowed with genius is a slave to his
genius,” and because in order “to manifest it be-
comes a need and a necessity which he can no
longer control,” society must be partly forgiven
for her various attempts to force the creativeness
of genius into channels acceptable to contempo-
rary mankind. Humanity of necessity moves
slowly and en masse, never with the spurt-like
rapidity and single-mindedness of the genius.
When our untiring genius Anally dies by natural
or other means after a most active and restless
life full of creativeness and often Ailed with bat-
tling against massed antagonism his creations can
then slowly be adjusted by the gradually develop-
ing new tastes and needs of mankind. The life of
the genius is almost always consuming itself in
expressing in his own way the liberation or ex-
teriorization of the tensions as they accumulate
within his innermost being. The author skillfully
illustrates the various kinds of benevolent creative
constructive human genius. He very wisely chose
to tell us of some of the main features which made
some of our most famous geniuses immortal and
did not dwell too much upon the details of Cretin-
ism.
“The Complete Weight Reducer”
By: C. J. Gerling.
Published by Harvest House, New York, 1941.
Price, $3.00.
The book is a comprehensive attempt to present
a guide for all those who believe themselves to
be in need of weight readjustment. The author
includes in his description of ways and means
many of the most widely publicized systems, foods,
drugs, mechanical devices, etc. It is hoped that
the information given between the covers of this
book will clear up for the weight-suffering man or
woman many popular notions and pleasing mis-
information. It is further expected that much of
the highly profitable food-fad and weight-adjust-
ment industry will appear to the reader in a saner
and fairer light. The savings derived fi’om a
better understanding ought to be considerable.
“Clinical Immunology Biotherapy and
Chemotherapy in the Diagnosis,
Prevention and Treatment
of Disease”
By: John A. Kolmer, M. S., M. D., Dr. P. H.,
Sc. D., LL. D., L. H. D., F. A. C. P., Profes-
sor of Medicine, Temple University School of
Medicine; Director of the Research Institute
of Cutaneous Medicine; and Louis Tuft, M.
D., Assistant Professor of Medicine and
Chief of Clinic of Allergy and Applied Im-
munology, Temple University School of Med-
icine.
Illustrated.
Published by W. B. Saunders Company, 1941,
Philadelphia and London. Price, $10.00.
The purpose of the book under review is to bring
under one cover the accumulated knowledge of
the past fifteen years on the subjects of immun-
ology, biotherapy and chemotherapy as applied to
human suffering caused by the 250 or so living
agents of vegetable and animal origin. The first
half, or Part I, deals with the general aspects of
infection, immunity, biotherapy, and chemother-
apy, while Part II is concerning itself with their
Continued on page 111
Nineteen Hundred and Forty-two — May
109
PROGRAM IN BRIEF
Maine Medical Association
Ninetieth A nnual Session
POLAND SPRING HOUSE
Poland Spring, Maine
Sunday, Monday and Tuesday
June 21, 22, 23, 1942
SUNDAY, JUNE 21, 1942
4.30 P. M.
First Meeting of the House of Delegates.
7.00 P. M.
Dinner.
8.30 P. M.
Guest Speaker, Reverend George W. Shepherd,
Boston
Subject: The Battle for Freedom in China and
India.
The Reverend Mr. Shepherd has lived for more
than twenty years in China. For the past
few years, while in China, he has been per-
sonal economic advisor for Generalissimo
Chiang-Kai Shek.
MONDAY, JUNE 22, 1942
Morning Session
9.30 A. M.-12.00 M.
Conferences
I
Traumatic Surgery
Chairman: William V. Cox, M. D.,
Auburn
II
Clinico-Pathological
Conducted by: Howard T. Karsner, M. D., Director
of the Institute of Pathology, Western Re-
serve University, Cleveland Ohio.
Chairman: Theodore E. Hardy, M. D.,
Waterville
Co-Chairman: Julius Gottlieb, M. D.,
Lewiston
III
Obstetrical and Gynecological
Chairman: Magnus Ridlon, M. D.,
Bangor
IV
Oto-Laryngological-Pediatric
Chairman: Pierre E. Provost, M. D.,
Augusta
Co-Chairman: Maurice E. Priest, M. D.,
Augusta
V
TUBERCimOSIS
Chairman: Edward A. Greco, M. D.,
Portland
Luncheon
12.30 P. M.
Tables will be reserved for reunions of alumni of
Boston University, Johns Hopkins, Bowdoin,
McGill, Vermont, Tufts, Yale and Harvard
Medical Schools, and members of the Tumor
Clinics.
Afternoon Session
2.00-4.45 P. M.
Scientific Session
1. Introduction of Visiting Delegates.
2. Endometriosis; Its Etiology, Symptoms and
Treatment.
Joe Vincent Meigs, M. D., Boston
3. Pathology — Subject to be announced.
Howard T. Karsner, M. D., Professor of
Pathology, Western Reserve University,
Cleveland, Ohio
4. Observations on Reversible Heart Disease,’
Merrill Sosman, M. D., Professor of
Roentgenology, Harvard Medical School,
Boston, Mass.
5.00 P. M.
Election of President-elect.
5.30 P. M.
Second Meeting of the House of Delegates.
Evening Session
7.00 P. M.
Dinner.
Presentation of Fifty-Year Medals by Presi-
dent P. L. B. Ebbett.
President’s Reception.
Dancing.
OVER
110
The Journal of the Maine Medical Association
TUESDAY, JUNE 23, 1942
Morning Session
9.30 A. M.-12.00 M.
Conferences
I
Annual Meeting of the Maine Medico-Legal
Society
President: William Holt, M. D.,
Portland, presiding
II
Surgery
Chairman: Isaac M. Webber, M. D.,
Portland
III
Public Health
Chairman: Roscoe L. Mitchell, M. D.,
Augusta
IV
Fractures
Chairman: Allan Woodcock, M. D.,
Bangor
V
Medical
Chairman: Blynn O. Goodrich, M. D.,
Waterville
Luncheon
12.30 P. M.
Tables will be reserved for Past Presidents and
County Secretaries.
Afternoon Session
2.00-5.00 P. M.
Scientific Session
1. President’s Address,
P. L. B. Ebhett, M. D., Houlton
2. Disability Valuations,
Speaker from Council of Industrial Health,
American Medical Association
3. Surgery of the Sympathetic System,
S. C. Harvey, M. D., Professor of Surgery,
Yale University, Surgeon-in-Chief, New
Haven Hospital
4. Differential Diagnosis of Obscure Cases,
Chester Keefer, M. D., Professor of Medi-
cine, Boston University School of Medicine,
Boston
5. Medical Aspects of Civilian Defense,
Allan Craig, M. D., State Medical Director
for Civilian Defense, Bangor
Evening Session
7.00 P. M.
Annual Dinner (Dress Informal).
Guest Speaker, Morris Fishbein, M. D., Editor,
The Journal of the American Medical Associ-
ation, Chicago
Sul)ject: Medicine and the War.
Special Notices
Annual Meeting Maine Medico-Legal
Society
The annual meeting of the Maine Medico-Legal
Society will be held Tuesday, June 23rd, 9.30 A. M.,
to 12.00 M., at the Poland Spring House, Poland
Spring, Maine.
PROGRAM
1. Business Meeting.
2. Discussion of Legal Angles of Medical Exami-
ner System.
Introduced by Franz U. Burkett, Former
Attorney General, Portland.
Discussion by Attorney General Frank I.
Cowan; Chief of State Police, Henry P.
Weaver; County Attorney, Cumberland
County, Albert Knudson; County Attor-
ney, Franklin County, Benjamin Butler.
3. Medico-Legal Aspects of Coronary Occlusion.
Joseph E. Porter, M. D., Associate Patholo-
gist, Maine General Hospital, Portland.
4. Forensic Pathology.
Alan Moritz, M. D., Professor, Legal Medi-
cine, Harvard University.
William Holt, M. D.,
President.
George L. Pratt, M. D.,
Secretary.
To the Ladies!
During the past few years the Ladies’ Register
has shown an increase in attendance. For instance,
in 1940, 122 women registered, and in 1941, there
were 156 registered. This increase in attendance
would seem to indicate that a “good time was had
by all.”
This meeting needs each one of you who can
possibly attend to help carry out it’s purpose of
being a social as well as an educational event.
All of you know by having been there, or by
reputation, the beauties of Poland Spring. All of
you know the value of the contacts made at these
June meetings. We feel sure that all of you want
to be there and have an active part in the program
arranged for you, and in the Sunday, Monday, and
Tuesday evening programs which will be as inter
esting to you as to your “doctors.”
Mrs. P. L. B. Ebbett, of Houlton, and Mrs. Carl
H. Stevens of Belfast, who will be in charge of
your entertainment are arranging a special pro-
gram. This program, to include a bridge party,
will be published in the June issue of the Journal.
We wish you could all be there, and request
those who can to register and receive a badge on
arrival.
Nineteen Hundred and Forty-two — May
111
Convention Rates
1942 Annual Session
Poland Spring House, Poland Spring, Me.
June 21, 22, 23, 1942
The following room rates, which include all
meals, will prevail:
Single rooms without bath $6.00 per day
Double rooms without bath, per per-
son $6.00 per day
Double room and single room with
connecting bath, for 3 persons,
per person $7.00 per day
Two double rooms with connecting
bath for 4 persons, per person ....$7.00 per day
Double room with bath for 2 persons,
per person .7 $7.00 per day
Single room with bath, per person $8.00 per day
The charge for non-registered guests for meals
will be as follows:
Breakfast $1.00
Luncheon $2.00
Dinner $2.50
Golf green fees will be $1.00 per day. The tennis
courts and Beach Club will be available without
charge.
The Hotel Orchestra will be available four hours
each day for dancing.
For reservations write the Poland Spring House,
Poland Spring, Maine.
Make Your Reservations Early
From the Secretary's Office
To the Members of the Maine Medical As.socintion:
We have been advised by Mr. Whitney, General
Manager of the Poland Spring House, that they
have planned an improvement program at both the
Poland Spring House and Mansion House which
they feel sure will contribute materially to the
comfort and pleasure of Maine Medical Association
members and guests attending the annual session
in June.
Mr. Whitney has also informed us that commenc-
ing last season it was necessary to charge for all
carbonated water dispensed due to the increased
cost of bottling. Poland Water is still served with-
out charge.
We call your attention to the one change that
has been made in the convention rates; a reduction
in the price of breakfast from $1.50 to $1.00.
Frederick R. Carter, M. D.,
Secretary.
Book Reviews — Continued from page 108
practical importance and application in the diag-
nosis, prophylaxis and treatment of disease. No
effort has been made to include detailed descrip-
tions of the technic of serologic or purely labora-
tory methods. However, their general aspect and
practical applications have received careful atten-
tion. The book is primarily prepared for the ben-
efit of the clinically and practically active physi-
cian but will no doubt prove of considerable value
for the teachers and students of the medical
sciences.
“Body Mechanics in Health and Disease^'
By: Joel E. Goldthwait, M. D., F. A. C. S., LL. D.;
Lloyd T. Brown, M. D., F. A. C. S. ;
Loring T. Swain, M. D.; and
John G. Kuhns, M. D., F. A. C. S.
With a Chapter on the Heart and Circulation as
Related to Body Mechanics.
By: William J. Kerr, M. D., F. A. C. P.
121 Illustrations.
Third Eldition. Completely Revised and Reset.
Published by J. B, Lippincott Company, Philadel-
phia, London, Montreal, 1941. Price, $5.00.
The earlier editions of this book placed special
emphasis upon chronic diseases associated with
faulty mechanics of the body: the present empha-
sizes the necessity of preventing as much as pos-
sible the development of faulty body mechanics.
The authors claim to have found that most chronic
diseases are associated with a wrong use of the
body which must have begun in childhood or in
early adult life. The purpose of this book is to
place before the medical profession those factors
which have been of the greatest help to the writers
in their treatment of patients suffering from
chronic diseases.
“Cardiac Clinics”
A Mayo Clinic Alonograph
By: Fredrick A. WilUus, B. S., M. D., M. S. in
Med,, Head of Section of Cardiology, Mayo
Clinic, and Professor of Medicine, Mayo
Foundation for Medical Education and Re-
search, Graduate School, University of Min-
nesota, Rochester, Minn.
Illustrated.
Published by The C. V. Mosby Company, St. Louis,
1941. Price, $4.00.
“Cardiac Clinics” is an ordered republication of
subject matter which previously appeared in the
Proceedings of the Staff Meetings of the Mayo
Clinic. The author was guided by the desire to
present concise, practicable discussions dealing
with the human heart and its functional variations,
especially arranged for the busy general medical
practitioner. He hopes that the volume will be
both interesting and helpful to all to whom it is
addressed.
“Immunity Against Animal Parasites”
By: James T. Culbertson, Assistant Professor of
Bacteriology, College of Physicians and Sur-
geons, Columbia University.
Published by Columbia University Press, New
York, 1941. Price, $3.50.
The author hopes to have supplied a text of value
to those who are beginners in the study of immun-
ity to the parasitic forms, by acquainting them with
the fundamental principles of the subject as now
understood. The readers are assumed to be well
trained in the two subjects of parasitology and
immunology^ The material is presented in a form
considered most useful for the beginning student,
the trained investigator, and the practicing physi-
cian or veterinarian. Personal concepts and the-
ories are held at a minimum.
112
‘‘Handbook of Communicable Diseases”
By: Franklin H. Topp, A. B., M. D., M. P. H.,
Director, Division of Communicable Diseases
and Epidemiology, Herman Kiefer Hospital
and Detroit Department of Health; Associate
Professor of Preventive Medicine and Public
Health, Wayne University, College of Medi-
cine; Special Lecturer in Communicable Dis-
eases and Epidemiology, University of Michi-
gan; Major, Medical Reserve Corps, United
States Army ; and
Collaborators.
With 73 Text Illustrations and 10 Color Plates.
Published by The C. V. Mosby Company, St. Louis,
1941. Price, $7.50.
The intention of the authors of this hook was to
create a text and handy reference book to be
profitably employed by all persons whose profes-
sional duties require them to be in contact with
communicable diseases and infestations and whose
duty it is to prevent or reduce their disease-pro-
ducing capacity. The diseases described have been
classified according to their most common portal
of entry. Though this is not the usual method of
presentation, the authors hope that this form will
prove to be more helpful to the student. However,
the conventional method of disease unit study has
been followed throughout the text, the individual’s
illness is clinically described in terms of onset,
symptoms, course, distribution of lesions, compli-
cations, treatment, and preventive measures. There
is a differential diagnostic appendix from the Her-
man Kiefer Hospital and a Glossary at the end of
the volume.
“Microbes W hich Help or Destroy Us”
By: Paul W. Allen, Ph, D., Professor of Bacteri-
ology and Head of the Department, Univer-
sity of Tennessee; D. Frank Holtman, Ph. D.,
Associate Professor of Bacteriology, Univer-
sity of Tennessee; and Louise Allen McBee,
M. S., formerly Assistant in Bacteriology,
University of Tennessee.
With 102 Text Illustrations and 13 Color Plates.
Published by The C. V. Mosby Company, St. Louis,
1941. Price, $3.50.
Most people are driven on in their efforts to
attain security for themselves and their dependents
by fear. Torturing fears become potent stimuli to
the mind of man. Its inventiveness creates myth-
ical enemies against which they attempt to fortify
and defend the self. Sooner or later, when fear
subsides and reason returns, fictional knowledge is
The Journal of the Maine Medical Association
slowly changing to factual knowledge, based on
actual, verifiable experience, and the actual causes
of man’s suffering can be defined and studied, and
their effectiveness reduced by the proper applica-
tion of antagonistic measures. The book under
review represents a mutual attempt of the authors
and their friends and advisers from the fields of
science and medicine to create for the benefit of the
lay reader a scientifically correct and linguistically
understandable textbook which informs him of the
importance and necessity of possessing practicably
correct knowledge of the micro-organisms which
forever try to undermine our health, happiness and
well being. It shows how we can defend ourselves
against the various powerful agencies and how we
can be more successful in avoiding disease, hunger
and exposure of the most varied kinds. Intelligent
knowledge of the agencies, organisms and systems
which tend to shorten our health, our life, our
activity in our pursuit of happiness is necessary
for the success of a dynamic culture.
“Chinese Lessons to Western Medicine”
A Contribution to Geographical Medicine from the
Clinics of Peiping Union Medical College
By: I. Snapper, Professor and Head of the De-
partment of Medicine, Peiping Union Medi-
cal College, Peiping, China.
With a Foreword by George R. Minot, Professor
of Medicine, Harvard University.
132 Illustrations.
Published by the Interscience Publishers, Inc.,
New York, 1941. Price, $5.50.
With the help of China Medical Board, Inc., and
the Peiping Union Medical College the author has
been placed in the enviable position to present to
his fellow physicians of the Western Hemisphere
what the physicians of the Eastern Hemisphere
have learned that is new. In a sort of bird’s eye
review the author describes the various types of
diseases which were treated at the Peiping Medical
College Hospital and Clinic. He could definitely
prove what has been suspected for the past five
decades, namely, that there is a geography of dis-
ease, that is to say, that man living in specified
territories and environments is likely to succumb
to diseases prevalent in that territory and conse-
quently must learn to fortify himself against
them. This seems to be true especially of the in-
fectious and parasitic disorders, disorders of the
liver, the cardiovascular and renal systems, etc.,
all of which is very interesting to the practitioner
of so-called Western Medicine.
WHY DON’T YOU i
GET YOUR PAY?i
Over 500 physicians and 20 hospitals have increased
their incomes by placing their accounts with us for / MAIL
adjustment, in a humane, honest and efficient ^ • without obligation
manner. So can you — let us tell you how. 1
Reference: Maine Medical Association Secretary 'Name 1
MEDICAL AUDITING COUNSEL y/^treet
297 WESTERN PROMENADE PORTLAND, MAINE /city \
The Journal
of the
Maine Medical Association
Uolume Thirlq^-three Portland, Ulaine, June, 1942
No. 6
Records: — The Problem of Every Hospital^
Peakl R. Fishee, R. ]ST., Superinteudeiit, Thayer Hospital, Waterville, Maine.
This title might be more aptly phrased
“The Headache of Every Hospital.” This
ailment exists in some degree or another in
all hospitals, although the admission of the
malady varies according to the inherent
frankness and perspicacity of the adminis-
trator. The cure or relief lies in the develop-
ment of a record-conscions staff. The utiliza-
tion of hospital records for teaching pur-
poses by the staff has an amazing therapeutic
effect.
Records are indispensable to the hospital
and the doctor alike, but their real value de-
pends entirely upon the manner in which they
are written and utilized. IST othing can do more
to improve the clinical work and raise the
standard of the hospital than developing good
clinical records. It has been said that the
examination of the records of any hospital
discloses its interest or lack of interest in
the progress of Medical Science.
Dr. Haggard, in his book, “The Doctor in
History,” said the chief importance of the
work of Hippocrates lies in the fact that he
observed and recorded the symptoms of
Disease. He began the accumulation of facts
concerning diseases, upon which the knowl-
edge of Modern Medicine exists. He wrote
down the symptoms and the courses of the
illness in the cases he studied. Such records
as how men behave when affected by disease
are called clinical records. All the knowledge
that j)hysicians have gained of Disease since
the time of Hippocrates has been acquired by
following the principles he laid down, — care-
ful observation of the sick. The importance
of writing down the results of one’s findings
makes for greater accuracy in observing. Of
the great physicians, none valued the worth
of good clinical records more than Sir Wil-
liam Osier. He made the statement that the
patient is the teacher, but unless observa-
tions are carefully recorded, little is learned
by the j^hysician, who should always be the
student. Dr. Joseph Pratt, in speaking to a
group of our doctors, said that it was a posi-
tive advantage not to have internes, if the
absence of. such assistance stimulated the
physician to keep good notes on his cases.
Unless, he said, a physician records his
observations, increase in his clinical expe-
rience means little, because he simply accu-
mulates impressions which lack accuracy, and
the exact details of individual cases which
are so imjDortant quickly fade from mind.
Much has been written about the impor-
* Presented at the annual meeting of the Maine Hospital Association, Lakewood, Maine, August 20,
1941.
114
tance of good records, and yet there are many
physicians who do not realize the practical
value of such records. Records should he
such that, should any unforeseen contingency
make it necessary for another physician to
carry on the case, he will he able to do so
intelligently and with complete information
regarding the patient. A good record, in
addition to all information pertaining to the
admission of the patient, should give a clear,
accurate, positive picture of the entire case
from admission to discharge, noting every-
thing that is done, and including the patient’s
response to various therapeutic measures,
together with an adequate summary and
prognosis. Progress notes are extremely im-
portant, especially when associated with un-
usual conditions, and should contain infor-
mation as to the character of wounds, the
removal of sutures and drains, treatments
administered by the physician, or any com-
plications. Accurate, complete records have
a very important place in medical research.
There should be some system for checking
records to see that all laboratory. X-ray,
pathological, and special reports have been
inserted, and the record arranged in proper
order and correctly signed before being filed
away.
It is generally conceded that adequate
facilities for the physician to record his
observations make for better records. A con-
veniently located and properly equipped
record room under the direction of a com-
petent record clerk is, of course, highly de-
sirable. If the record clerk is intelligent,
personable, and tactful, this is a decided asset.
It is too often felt that in providing these
ideal facilities, this headache of hospital
records should be relieved. Many times this
leads to disappointment. We have all seen
adequate equipment and competent personnel,
with poor records, delinquent in preparation,
inadequate descriptively, and useless scien-
tifically. Perhaps the physician considers the
record mere routine, a form of red tape, a
necessary evil ; or perhaps his inertia is
caused by the lack of appreciation of the
real teaching value of a good record.
Medical records should be written for their
teaching value. Through such records the
The Journal of the Maine Medical Association
patient receives better care, the physician
increases his knowledge, and Medical Science
as a whole is benefited. To accomplish this
threefold purpose, the development of a
record - conscious staff is necessary ; not
always easy, yet not always as difficult as it
may seem. While the responsibility for
writing good medical records is primarily
the physician’s, it is the responsibility of the
hospital to develop this idea of utilizing the
hospital record. Too frequently medical
records are written and forgotten and put to
no further use. They are not studied for the
purpose of increasing the clinical knowledge
and experience of the staff. Records must be
used, and in such a way as to make their
value unquestioned. It is generally conceded
that a good record committee is essential in
keeping records up to the recognized stand-
ard. Incidentally, the suggestion sometimes
made that the most delinquent staff member
be placed on such a committee for purposes
of reformation does not work out in practice.
The record Committee should be composed
of keen, interested men, well versed in record
procedure.
The laxity of some hospitals in not insist-
ing upon records being written on time and
kept alwaj^s up to date naturally engenders
a feeling on the part of the physician that
it is a mere formality. Also, delinquent
records are apt to lack accuracy.
Frequent, well-organized, interesting staff
meetings, in which careful studies of selected
cases from patients in the hospital receive
honest evaluation with frank discussion, is
bound to develop a more keen appreciation of
the importance and necessity of writing good
records. Xo physician can trust to his mem-
ory all the essential details pertaining to his
patients. The source of material for the
discussion of his cases must be obtained from
complete, accurate, and well-written records.
The staff progTam should include cases chosen
for their teaching value. A diversified selec-
tion, apportioned among the staff, to give the
doctors opportunity and experience in pre-
senting cases will, over a period of time,
develop a more interesting and instructive
tyj3e of meeting. Here again the hospital can
make it easier for the doctors to present their
Nineteen Hundred and Forty-two — June
cases interestingly and gTaphically by pro-
viding the proper physical equipment, such
as blackboard, a viewing box for X-ray films,
and a screen with reflectoscope for showing
charts, etc. It has been stated that the
greatest educational value of the medical
record lies in the impossibility of evading
errors. Errors are the best teachers when
they are brought to light and the cause is
sought. If the staff becomes interested in
what Osier termed “observation, tabulation
and recording,” this is soon reflected in the
quality of the records and the clinical work
of the staff.
The staff meeting program is largely taken
up with discussion of the more interesting
cases, presenting problems of educational
value. It is, of course, impossible to discuss
every case. Obviously, pertinent phases of
many cases meriting review are overlooked.
The staff audit, described by Dr. Thomas
Ponton, is a most practical method of ap-
praising the entire professional work of the
hosj)ital, and, in our own experience, has been
a means of greatly improving the hospital
records. This system, with some modifica-
tion, can be adopted by almost any hospital.
Once each week the completed records are
carefully reviewed by some member of the
staff designated as Auditor, together with the
Chairman of the Staff and the members of
the Record Committee. Each staff member
acts as auditor for one month, in rotation.
This allows each member to participate in the
audit, and still lends continuity to the scheme.
Cases are classified as to type, risk, and result.
The essential point of the staff audit is that
for each patient there must be an honest com-
parison of the result secured with that which
might be reasonably expected. Records are
very carefully reviewed for errors in diag-
nosis, treatment, judgment, and technique.
The object is not to place the blame on any
one person, but to find successes and failures
of all kinds in order to bring about an im-
provement and to stimulate interest in the
professional work in general. The form and
content of the record is very carefully gone
over and, should the record reveal any errors
or omissions, a confidential note is given to
the physician regarding the same and sug-
gesting changes. This information is also
115
recorded on a Master Sheet, which is kept by
the Record Clerk. It is her responsibility to
see that the physician makes the necessary
changes before the record is cross-indexed or
filed. During the one and one-half years that
we have employed this system, it has brought
to light a wealth of informative, interesting
material which could be used by the staff.
Once a month, a consolidated report is made
and presented to the doctors at staff meeting
for discussion.
Of course the inauguration of some such
system of audit is not an immediate answer
to the problem of hospital records. Its great-
est value is in developing a cooperative and
scientific spirit on the part of the staff, who
begin to see the real practical value of their
own hospital records. In other words, these
records are written for use, rather than mere
filing. All this takes a little time. In our
own case, this plan was received at first with
considerable indifference by the staff as a
whole, but through the enthusiastic efforts of
a minority, the audit was started and has
developed gradually into something that has
exceeded our fondest expectations. In the
first few months, certain significant, but
hithertofore unrecogTiized deficiencies, were
brought to light, obviously a matter of con-
cern to the hospital and the staff. As time
went on, other errors were discovered and
corrected. The value of all this and the im-
portance of the records became apparent to
each staff member as he had the opportunity
of serving as auditor. This plan enables the
entire clinical work of the hospital to be
reviewed by the individual staff member.
This is bound to increase his own interest
and develop an inquiring attitude, and
results in a more cooperative spirit. The
gTeatest difficulty with the record problem is
overcome when the physician realizes, through
his own experience, that his records are put
to a practical use, that they are not insisted
upon by the hospital simply to gain the
approval of the American College of Sur-
geons. In our own experience, this has solved
the problem of delinquent records. No records
are filed away until they are completed and
have gone through the audit. Naturally, no
one wants his records reported as incomplete.
Continued on page 121
116
The Journal of the Maine Medical Association
Laceration of the Abdomen with Ectopia Viscera^
By IST, Bisson, M. D., Waterville, Maine.
Extensive laceration of the abdomen with
ectopia viscera presents a two-fold problem;
the combatting of shock, always a factor, and
the restoration of the abdominal contents,
with the prevention or control of peritonitis.
In the following case it was possible to ac-
complish these things simnltaneonsly, largely
through cooperation and teamwork. At the
same time the role of chemotherapy in the
prevention of peritoneal infection cannot be
ignored.
F. IST., male, age 36, was seen immediately
upon admission to the Thayer Hospital, in
profound shock from an extensive laceration
of his abdominal wall. This had resulted
from being struck by a board thrown loose
from a circular saw. On removing his cloth-
ing most of his small intestines were found
outside the abdomen. There was an irregular
wound in the wall extending from just
above the symphysis pubis almost to the
left superior iliac spine and thence upward
for about 8 inches.
Drs. T. E. Hardy and W. L. Gousse were
called in immediate consultation and parti-
cipated in the conduct of the case. It was
felt that the best chance for recovery lay in
proceeding forthwith to restore the abdomi-
nal contents and to simultaneously treat the
shock. Ether was considered the anesthetic
of choice.
The wound was gently irrigated with nor-
mal saline and considerable debris, consist-
ing of pieces of wood, bark, pitch, gravel,
and fecal matter was removed. A tear, 8
inches in length, was found in the omentum
and inspection of the small intestines re-
vealed 6 distinct perforations ranging from
1/2 to 2 inches in length. After thoroughly
cleansing the wound, all bleeding points
were ligated and the perforations in the in-
testines closed with Ho. 00 chromic cat gut
on an atraumatic needle. Powdered sulfa-
nilamide was applied freely to the intestines
before returning them to the abdominal cav-
ity and was also dusted into the cavity.
* From the Thayer Hospital.
The wound was closed except for 2 cigarette
drains in the lower angle of the incision.
During this entire procedure shock was
continuously treated under the supervision
of Dr. Hardy. 500 cc. of 5% glucose in nor-
mal saline was given intravenously and a
duodenal tube was inserted. The patient
stood the operative procedure well and
showed remarkably good recovery from his
shock.
The patient was returned to bed with the
duodenal tube in situ. A prophylactic dose
of tetanus antitoxin was given, after previ-
ously skin testing and finding no reaction.
For the first 6 hours it was repeatedly neces-
sary to irrigate through the duodenal tube
because of a large amount of solid food re-
tained in his stomach. Intravenous glucose
and saline were administered post-operative-
ly. After 24 hours sulfathiazole was given
through the duodenal tube, maintaining a
blood concentration of 2.5 mm.%. The duo-
denal tube was removed on the 5th post-
operative day.
The patient ran a slight temperature, nev-
er above 100.2 for almost 9 days, after which
it remained normal. While he complained
of some epigastric discomfort, there was no
distension of his abdomen. Peritonitis did
not develop and the drainage was entirely
serous. The drains were removed on the 8th
post-operative day and the incision healed
by the 10th day.
On the 9th day the patient became nause-
ated and vomited considerable greenish fluid.
The abdomen, while distended, appeared
slightly full. Beginning intestinal obstruc-
tion was thought of and the duodenal tube
was reinserted. 3 hours later he vomited
again and expelled the tube. X-ray examina-
tion showed distension of the small bowel
loops in the upper right portion of the abdo-
men. He resj)onded well to enemata, how-
ever, and the vomiting ceased. From then
on his convalescence was uneventful. He was
discharged home on the 16th day.
Continued on page 121
Nineteen Hundred and Forty-two — June
117
P. L B. EBBETT
President Maine Medical 'Association, 19^1-19^2
118
The Journal of the Maine Medical Association
The President's Page
To the Members of the Maine Medical Association:
As this will be my last message to you as President of your Association, I first want to
express my appreciation of the assistance each and every member, I have called on, has given me.
I greatly appreciated the honor the office carried with it, and I have tried to the best of my
ability to carry on for the good of the Association. I know my efforts have been faulty, but they
were sincere.
Soon we will be meeting at Poland Spring to consider our program for the ensuing year, and
as this promises to be a year of great problems for the Medical Profession, as well as for our
Country at large, I feel all who possibly can should be present to discuss these problems and
formulate methods of overcoming them. To me it seems that this is one of the most important
meetings our Society has ever held, and I think you will all agree with me in saying that the prob-
lems which have been thrown on our profession by this War have never before been equalled. Let
all of us who can, then, get together and find a solution.
The main problem in my opinion will he, with our depleted ranks, to care for our civilian
population. Along with possible war casualties, have we given thought to epidemics, such as the
flu of the world war, which may develop? Have we made adequate preparation for the care of
such situations? This is only one of the many problems which confront us in the coming year.
Think of the conditions we may have to meet : Think of means of taking care of them and
express your opinions at our meetings.
Our Scientific Committee, by untiring effort, has prepared an excellent program for our
meeting which should prove valuable to all who attend. Let us show our appreciation of their work
by attending.
I hope every delegate will be present to take part in all discussions, and by their votes,
decide our policy for the coming year, and I hope every member who can will attend the House
of Delegates’ meetings, as well as the general business meetings, feel free to enter all discussions,
and make clear their ideas on any and all questions. In other words, although, if you are not a
delegate, you have no vote in the House of Delegates’ meetings, your opinions are welcome and
desired. Let us have no fifth column in the Maine Medical Association. Let us do our criticizing
in the meetings.
I have enjoyed visiting the various Societies of the State. All have received me very
graciously and I assure you I greatly appreciated your cordiality.
In closing, I again desire to ask your attendance at our June 21st to 23rd sessions, bearing
in mind that although this meeting is being held at Poland Spring, a pleasure resort, it is not an
outing, but a business meeting which has to do with medical problems, the welfare of our com-
munities and the advancement of medical standards throughout our State and Nation.
Thanks to you all for your help in my endeavors and for your patience with my mistakes
in trying to carry on as President of your Association.
P. L. B. Ebbett, M. D.,
President, Maine Medical Association.
Nineteen Hundred and Forty-two — June
119
Editorials
Concerning the Proposal to Tax Hospitals and Colleges
Since the foundation of onr government by
custom and law exemption from taxation has
heen provided for certain institutions. The
Revenue Act in 1913 specifically through
Section 101-(6) made legal provision where-
by certain corporations, etc., organized and
operated exclusively for religions, charitable,
scientific, literary or educational purposes,
in which no part of the net earnings inured
to the benefit of any private shareholder or
individual were exempt from taxation. All
this is to be changed, if and when the recom-
mendations of the Treasury Department
should unfortunately become enacted and the
proposed amendment made enforceable by
law. To hold institutions conducted solely
for charitable purposes subject to any form
of taxation seems the last word in unfairness.
It has been the plaintive cry of certain Fed-
eral bureaus that a large percentage of the
population of this country is ivitJioiit ade-
quate hospital facilities, a statement shown
to be without foundation, yet in these times
of admitted danger to onr very lives and
existence a ^^I’oposal is made to impose a bur-
den that would seriously impair, if not de-
stroy, the ability of practically all of these
institutions to carry on.
The almost unthinkable proposal is in-
cluded in the amendment proposed to the In-
ternal Revenue Code that any profit made by
hospitals on paying patients will be a busi-
ness income and the expenditures of the same
hospital for care of charity patients will not
be deductible in determining the net income
on paying patients, except to limit of 5 % net
income. It certainly iis a fact that hospitals
are running a business but it is most emphat-
ically a type of business that a community
lacking it is unfortunate indeed. With re-
turns from endowment funds at a low level,
with financial assistance by generous friends
limited by conditions impossible to remedy
for the duration of the war and with many
a commnnity institution fighting hard to ren-
der the service it knows to be a necessity, one
can truly ask; what next? Probably a sug-
gestion to tax the baby’s bank.
It has well been said, ‘fihere is no need to
elaborate further on the effect of this on the
health and morale of the entire civilian popu-
lation.” One might even go further and
entertain the perfectly legitimate conclusion
that the author or authors of such a proposal
have demonstrated their utter lack of appre-
ciation of the services being rendered to this
country, noiv as never before, by institutions
they would seriously handicap or might even
destroy.
It is the legitimate duty of each and every
citizen to protest against limitation of ex-
emption for religious, charitable and educa-
tional institutions. Hospitals and colleges
are needed, not only to aid in winning the
war, they are needed in maintaining our
existence.
The Annual Meeting
Some twenty-five years have passed since
the annual meeting of the Maine Medical
Association was held with the nation at war.
Many of our members are in the armed and
other services, more are being called and im-
perative requirements indicate that further
demands will be made and met. Those who
remain at their civilian jobs face a tremen-
dous responsibility ; the burden of added
work may seriously tax the physical ability
of many to which will be added a rapidly
amounting increase in government financial
demands in way of taxation. Few, if any,
will drift with the tide and rest on their oars ;
120
all must pull against tke current of this sav-
age and ruthless war which can well smash us
on the rocks of defeat and bring to this coun-
try conditions of such gravity that no single
mind can grasp their final implications.
As might be expected no little of our pro-
gram will deal directly or indirectly with
military medicine. Dr. Fishbein, who comes
as our dinner speaker, will bring us facts con-
cerning the obligations of medicine in the
crisis of today. The State Director of the
Procurement and Assignment Service, Dr.
John G. Towne, will welcome the opportun-
ity to clear any confusion in the minds of
those who are in doubt on any or certain
points. Through and by the House of Dele-
gates the business commitments for the com-
ing year will be determined and here again
will come an added burden to those who will
serve in official and appointed capacities.
At no other time does so favorable an op-
portunity present for AHY member to sug-
gest anything which he feels will be of bene-
fit to the association. It is not only an oppor-
tunity, it is a direct obligation. The status of
every person in this country changed that
hideous day at Pearl Harbor. To a marked
degree that obtains with the profession of
medicine individually and collectively. There
The Journal of the Maine Medical Association
isn’t a single member of the official family of
our association but will welcome suggestions
whereby we can progress. If any deference
is felt about appearing before the House of
Delegates any member has welcome access to
any councilor, member of his County repre-
sentation on the House of Delegates or com-
mittee member. Every president of this asso-
ciation for some years past has included in
their messages a request for constnictive
criticism and suggestions. It can be said em-
phatically that these messages were made in
the hope that responses would follow.
The program speaks for itself as to its
value in our daily work. The announced con-
ferences have provided a wide diversification
of subjects for presentation and they also
afford an opportunity for discussions that are
somewhat impossible in the more formal and
larger meetings. The last meeting held at
Poland Spring was one of the most successful
and enjoyable in the history of our associa-
tion. By our individual and collective efforts
we can dnplicate that pleasant record and it
is well to remember the statement of Dr.
C. C. Weymouth, the Chairman of the Scien-
tific Committee. “Ho one knows what next
year will have in store, so let’s make this a
grand get-together.”
Our Friends the Exhibitors
Challenged by the demands of the govern-
ment with its system of war-time priorities,
our friends the exhibitors again stand by us
our first year of this all-out war as they al-
ways have in the past. While it is a fact they
lessen the burden on the State Association
treasury to conduct the annual meeting, they
do even more. They bring to us a most valu-
able and instructive display of the “tools of
our trade” when we can or should have more
leisure to see and hear about them. They are
entitled to more than a mere written expres-
sion of thanks ; they should have our personal
•acknowledgment of our appreciation which
can very nicely be shown by visiting the vari-
ous booths. Some of the friends who have
always been with us find it impossible to do
so this year. Like Old Mother Hubbard their
cupboards are bare. Others, with us for the
first time, should be given a most cordial wel-
come and made to feel that their expense and
trouble in these troublesome times has been
justified. What the forthcoming year or
years may hold in store in matter of short-
ages, time and time alone will tell. This may
be even obligatory with necessary medical
apparatus and sujDplies of all kinds. How-
ever, being in the hands of our friends is no
small blessing.
Nineteen Hundred and Forty-two — June
121
Records : The Problem of Every Hospital — Continued Jrom page 115
Each member takes pride in having his
records written on time and with progTess
notes lip to date, ^inother noticeable im-
provement has been in the content of the
record. They are criticized as to form, com-
pleteness of detail, logic and even English.
The correction of papers in any English course
is an accepted form of teaching. This works
quite as well with hospital records.
To summarize :
The problem of records is quite universal
with hospitals. The responsibility for records
rests primarily with the physician. The
physician is nsnally a practical person, busy,
and not likely to be forced to do things which,
to him, seem a mere formality. Too often the
hospital record has been just that, — a routine
something of little practical use. Little effort
has been made to show the physician the
practical value of records or to utilize them
for his own benefit. Providing adequate
physical facilities, although essential, is not
enough. Eecords must be used, not filed and
forgotten. It is the responsibility of the
hospital to develop the idea of utilizing hos-
pital records. A gi’eat deal can be accom-
plished by using records for case teaching in
the staff meetings. In our own experience,
the staff audit has proven to be the best means
of solving our record problem. It has made
every staff member coguiizant of the practical
value of records, and has put the records to
practical use by the staff. In addition, the
Staff has been able to accumulate data of
scientific value. It has taken care of the
problem of delinquency and has improved
the content and form of the records. It has
developed a real cooperative, constructive
spirit. The cure of this malady, this head-
ache of the hospital, lies in the development
of a record-conscious staff.
Laceration of the Abdomen ivith Ectopia Viscera — Continued from page 116
Comment
A number of factors enter into the rather
surprisingly good results achieved in this
case. Undoubtedly the use of chemothera-
peutic agents locally is of value in the pre-
vention of peritonitis. Sulfanilamide would
seem preferable for local use over the other
sulpha drugs, because of its gTeater solubil-
ity. A proper blood concentration should be
maintained through oral administration un-
til the danger of infection is past. Of still
greater importance, in my opinion, was the
cooperation and team-work manifest in the
Tuberculosis is a vanishing disease. Per-
haps we are a little hypnotized by that fact.
When this century began we know that tu-
berculosis claimed more than 200 victims
annually from every 100,000 of our popula-
tion ; today, four short decades later, tuber-
culosis has been driven from top billing down
to a shaky seventh. But these facts do not
tell all of the story. Tuberculosis is still the
leading cause of death in those of college
operating room. Shock was continuously
treated while the surgical repair was carried
out as expeditiously as possible. A favor-
able factor in this case was that because of
the nature of the injury there was practical-
Iv no work done inside the abdominal cav-
V
ity, the repair being done on the contents
extra-peritoneally.
Rapid but careful surgery with good team-
work is important in any emergency opera-
tion and will save many lives and avoid
many complications. This demands the co-
operation of the surgeon, his assistants, and
the anesthetist.
age. Tuberculosis is still as much of per-
sonal catastrophe for the individual who con-
tracts it today as it ever was in the past.
Tuberculosis has lost none of its ability to
ruin a career, wreck family budgets, burden
taxpayers, or bring suffering and disability
to thousands of Americans, no one of whom
deserves or needs to contract tuberculosis if
everyone utilized fully what medical science
knows and has to offer. — Chaeles E. Lyght,
M. D.
122
The Journal of the Maine Medical Association
County News and Notes
Cumberland
Portland Medical Club
The regular monthly meeting was held at the
Eastland Hotel, April 7, 1942, at 8.15 P. M. In the
absence of the President, the Vice President, J. C.
Oram, M. D., presided. There were thirty members
and four guests present.
B. B. Foster, M. D., presented a paper on the
Discussion of the Interpretation of Pre-Marital
Blood Reports. He stressed the part played by
false positive serologic tests. O. R. Johnson, M. D.,
spoke of the variability of the reports of the sero-
logical blood tests. O. E. Haney, M. D., spoke of
practical problems as encountered in otRce prac-
tice, and emphasized the importance of making
the right decision at the right time. Leon Babalian,
M. D., felt that two laboratory tests should be done
and referred to the increase of syphilis in war
periods. Others entering into the discussion were
Drs. Mortimer Warren, George C. Poore, Edwin H.
Gehring, Benjamin Zolov, and guests Drs. Roscoe
Mitchell, Glenn Usher, and Arch Morrell of
Augusta.
Resolutions on the death of William D. Ander-
son, M. D., were adopted by the Club.
It was announced that E. R. Blaisdell, M. D.,
and Langdon T. Thaxter, M. D., were to be the
speakers for the May meeting with the subject.
Acute Low Buhsternal and High Epigastric Pain
(Possible Errors in Differential Diagnosis).
Following the meeting light refreshments were
enjoyed.
Respectfully submitted,
Alice Whittier,
Secretary.
Kennebec
A meeting of the Kennebec County Medical Asso-
ciation was held at the Veterans’ Administration,
Togus, Maine, on Thursday, May 21, 1942.
Clinical Session at 5.00 P. M., which was pre-
sided over by L. Armand Guite, M. D., President:
1. Dendritic Keratitis — Eli Contract, M. D.
2. Septicemia — M. Z. Cooper, M. D.
3. Myasthenia Gravis — Joseph Glasser, M. D.
4. Carcinoma of Stomach with Subtotal Resec-
tion— William W. Hardman, M. D.
5. Subacute Bacterial Endocarditis — N. H.
Badaines, M. D.
Dinner at 6.30 P. M., which was followed by a
business meeting. Minutes of the last meeting
were read and approved.
The speaker of the evening was Richard H.
Overholt, M. D., who is associated with the Massa-
chusetts General Hospital. His subject was In-
juries and other Thoracic Problems. Dr. Overholt’s
paper was very interesting and was amplified by
lantern slides. A general discussion followed.
There were 36 members and guests present.
Respectfully submitted,
Frederick R. Carter, M. D.,
Sec7"etary.
Penobscot
The Penobscot County Medical Association held
its regular meeting on Tuesday, April 21, 1942, at
the Bangor House, Bangor, Maine.
The subject for the evening was Medical Aspects
of War Services.
P. L. B. Ebbett, M. D., President of the Maine
Medical Association, was present and spoke to the
group.
Allan Craig, M. D., of Bangor, Medical Director
for the State of Maine, described the situation rela-
tive to hospital organization, casualty stations, and-
first aid services.
General John G. Towne of Waterville, coordi-
nator of the Selective Service organization for
Maine, spoke on the Selective Service; on the sub-
ject of Rehabilitation: and, at somewhat greater
length, on the Procurement and Allotment of
physicians for military and civil services.
An extremely interesting “question and discus- -
Sion’’ period followed the speakers’ program.
There were 59 present.
Respectfully submitted,
Forrest B. Ames, M. D.,
Secretary.
Somerset
Franklin-Kennebec
A joint meeting of the Somerset, Franklin and
Kennebec County Medical Societies was held on
Thursday, April 23, 1942, at the Elmwood Hotel,
Waterville, Maine.
Dinner at 6.30 preceded the evening program
which follows:
Meningococcus Meningitis, R. P. Laney, M. D.,
Somerset County.
Cerebellar Tumor in a Child of 12 Years, T. Den-
nie Pratt, M. D., Kennebec County.
Ulcerative Colitis, George L. Pratt, M. D., Frank-
lin County.
Guest speaker of the evening was Allan Craig,
M. D., of Bangor, Chief of Emergency Medical
Service for the State of Maine.
Maurice E. Lord, M. D., Secretary,
Somerset County Medical Society.
HAVE YOU MADE YOUR RESERVATIONS FOR THE
ANNUAL MEETING?
Nineteen Hundred and Forty-two — June
123
Councilor Reports
Report of C ouncilor, First District
To the Officers and Menihers of the Maine Medical
Association :
The following is the annual report of the Cum-
berland and York County Societies:
CUMBERLAND COUNTY
No meetings were held in the summer, but start-
ing in October, the Society met each month except
November and April. The progi’ams for the meet-
ings were very good and well diversified. At 5.00
P. M., of the meeting day. Dry Clinics were held
at the Maine General Hospital. These gatherings
mean a lot of work on the part of the committees.
The only criticism I have to make is that there is
not better attendance.
Active Membership 157
Honorary Membership 6
Service Members 15
New Members 11
Deceased 4
New Members— Henry S. Hebb, M. D., Bridgton;
Joseph G. Ham, M. D., Portland; Arthur Wood-
man, M. D., Falmouth Foreside; Sidney R. Bran-
son, M. D., South Windham; K. Alexander Laugh-
lin, M. D., Portland; Albert C. Johnson, M. D.,
Portland; Eugene P. McMananey, M. D., Portland;
Leo J. McDermott, M. D., Portland; William Monk-
house, M. D., Portland; Ralf Martin, M. D., Port-
land; James Patterson, M. D., South Portland.
Deceased — Herbert J. Patterson, M. D., Port-
land; Charles B. Sylvester, M. D., Portland;
Bertram F. Dunn, M. D., Portland; William D.
Anderson, M. D., Portland.
Officers — President, Roland B. Moore, M. D.,
Portland; Vice President, N. B. T. Barker, M. D.,
Yarmouth; Secretary-Treasurer, Eugene E. O’Don-
nell, M. D., Portland.
Board of Councillors — George W. Cummings,
M. D., Portland; George Tibbetts, M. D., Portland;
Luther Brown, M. D., Portland.
Legislative Committee — E. W. Gehring, M. D.,
Portland; F. A. Ferguson, M. D., Portland.
Committee on Public Relatio^is — Harold V. Bick-
more, M. D., Portland; Theodore E. Bramhall,
M. D., Portland; Roderick L. Huntress, M. D.,
Portland.
Delegates to the Maine Medical Association —
Thomas A. Foster, M. D., Portland: Frank A.
Smith, M. D., Westbrook; DeForest Weeks, M. D.,
Portland; Elton R. Blaisdell, M. D., Portland;
Philip H. McCrum, M. D., Portland; Clyde E.
Richardson, M. D., Brunswick; Richard S. Hawkes,
M. D., Portland.
Alternate Delegates — Edward A. Greco, M. D.,
Portland: L. L. Hills, M. D., Portland; Alvin
Ottum, M. D., Portland; Francis Hanlon, M. D.,
Portland.
Meetings:
October 16, 1941 — Eastland Hotel. Walter Tobie,
M. D., Portland, Maine, was the speaker and his
subject was “An Old Fashioned Medical School.”
This meeting was the largest attended of the year.
Doctor Tobie very cleverly, with wit, humor, and
pictures, depicted Bowdoin Medical School of the
“Gay Nineties.”
December 5, 1941 — Eastland Hotel. Captain
R. P. Parsons of the United States Navy Medical
Corps presented a paper entitled “Some Problems
in Naval Medicine.”
January 16, 1942 — Eastland Hotel. Duncan Reid,
M. D., Boston, Mass., speaker. Subject, “Toxemia
of Pregnancy.” Charles Robie, M. D., discussed the
“Pharmacology of Veratrum Viride.”
February 27, 1942 — Eastland Hotel. Speaker,
Chester Keefer, M. D., Boston, Massachusetts. Sub-
ject, “Treatment of Bacterial Meningitis.”
March 27, 1942 — Lafayette Hotel. Speaker, Gor-
don Morrison, M. D., Boston, Massachusetts. Sub-
ject, “Treatment of Fractures.”
YORK COUNTY
Active Membership 50
Honorary Membership 2
Members in Service 4
New Members 4
Deceased Members 1
Neio Members — J. Robert Downing, M. D.,
Kennebunk; John Murphy, M. D., North Berwick;
Robert D. Vachon, M. D., Sanford; Marion K.
Moulton, M. D., West Newfield.
Deceased Member — Harris P. Illsley, M. D.,
Limington.
Officers — President, Carl E. Richards, M. D.,
Alfred; Vice President, Arthur J. Stimpson, M. D.,
Kennebunk; Secretary-Treasurer, Charles W. King-
horn, Kittery.
Delegates to the Annual Meeting at Poland
Spring — Edward M. Cook, M. D., York Harbor;
W. L. Morse, M. D., Springvale; J. H. MacDonald,
M. D., Kennebunk.
Alternates — Carl E. Richards, M. D., Alfred;
Paul S. Hill, Jr., M. D., Saco; C. W. Kinghorn,
M. D., Kittery.
Meetings xvere held quarterly:
Summer get-together was held at the summer
home of Dr. Paul Hill at Biddeford Pool, on
August 27, 1941. Dr. Paul served the confreres
with one of his famous sea-weed cooked shore din-
ners— nuf ced. Large attendance, with golf, games,
and cards. No regrets.
Fall meeting, October 22, 1941. Kennebunk Inn,
Kennebunk. Speaker, Captain Robert R. Parsons,
M. C., U. S. N. Subject, “Modern Concepts on
Gonorrhoea.”
Winter meeting, January 7, 1942. Normandie,
Scarboro. Speaker, J. L. Pepper, M. D., Portland,
Maine, District Health Officer. Subject, “Conta-
gions and Infections.”
Spring meeting, April 8, 1942. Hillcroft Inn,
York Harbor. Speakers: Lt. Commander Eugene
Drake, M. C., U. S. N. Subject, “Medicine.” Rolf
Luim, M. D., Portsmouth, N. H. Subject, “Sur-
gery.” David Dolloff, M. D., Biddeford. Subject,
“Civilian Defense.”
More interest is being taken in the County Meet-
ings, with better attendance, discussions, and good
fellowship. During the year, a minimum fee sched-
ule was standardized throughout the County. This
is operating successfully and is of great financial
help, especially to the doctors in Country Practice.
Respectfully submitted,
Stephen A. Cobb, M. D.,
Councilor, First District.
124
Report of Councilor, Second District
To the Officers and Members of the Maine Medical
Society :
The following is the annual report of the
Androscoggin, Franklin and Oxford County Medi-
cal Societies:
ANDROSCOGGIN COUNTY
The County Society has held eight regular meet-
ings, starting with the September 18th meeting in
1941 and will hold one more meeting on the 23rd
of May. Our programs have been varied and
quite successfully presented. At the September
meeting, H. E. MacMahon, M. D., Tufts Medical
School, discussed the problems of tumors.
Dinner preceded the October 23rd meeting, fol-
lowing which Louis Wolfson, M. D., of Boston,
presented a paper on plastic surgery, paying par-
ticular attention to the treatment of burns. His
paper was accompanied by lantern slides demon-
strating the results obtained.
Edward T. Whitney, M. D., of Boston, was guest
speaker at the December 11th meeting and pre-
sented a most interesting paper concerning the
treatment of varicose veins and hemorrhoids.
The first meeting of 1942 was held on January
29th and Frank Barton, M. D., surgeon from the
Massachusetts Memorial Hospital and director of
the blood bank, presented a paper on the manage-
ment of the blood bank at the Massachusetts Me-
morial Hospital and showed moving pictures
which brought out the various procedures carried
out during the collection and processing of the
blood. Election of officers was held as follows:
President, Camp Thomas, M. D.; Vice President,
D. D. F. Russell, M. D.; Secretary-Treasurer,
Charles Steele, M. D.; Delegate to Maine Medical
Association for two years, M. S. F. Greene, M. D.;
Alternate, A. W. Plummer, M. D.; Councilor to
County Society, Romeo Belliveau, M. D.
On February 19, 1942, Charles Rammelkamp,
M. D., Senior Resident at the Massachusetts Me-
morial Hospital, presented a paper concerning
some of the more recent aspects of chemotherapy
with special reference to the use of Gramicidin.
The results of these treatments were summarized
on lantern slides.
The County Society was most fortunate in that
they received an invitation from the Twin Cities’
Executive Club to attend their March 19th meet-
ing at which time Morris Fishbein, M. D., Editor
of the J. A. M. A. was their guest speaker. Many
of the members attended the meeting and heard
Doctor Fishbein speak of the problems of medi-
cine and the changing social order. Since this
meeting occurred on our regular meeting night,
the society decided to consider this as the regular
meeting for the month.
Donald Munro, M. D., of the Boston City Hos-
pital, addressed the meeting held April 23rd and
talked about the treatment of head injuries. He
emphasized the importance of first treating sur-
gical shock and the debridement of compound frac-
tures of the skull. At this April meeting we con-
sidered the fee schedule concerning the medical
care of State wards and State cases, as approved
by the Council of the Maine Medical Association
on October 16, 1941, and referred to the various
county societies for action. It was moved by Dr.
Webber and seconded by Dr. Higgins that the
Androscoggin County Medical Society approve the
fee schedule as recommended by the Council of the
Maine Medical Association at their meeting on
October 16, 1941, providing the following two
changes were made; that the general practice office
The Journal of the Maine Medical Association
call fee be raised from $1.00 to $1.50 and that the
stipend for a similar office call for nose and throat
situations be reduced from $3.00 to $1.50. The so-
ciety voted unanimously in favor of the above
motion.
At this same meeting, E. C. Higgins, M. D., of
the Central Maine General Hospital Staff and R.
Blinn Russell, M. D., of the St. Mary’s Hospital
Staff were appointed to the Medical Advisory
Board of the Red Cross.
During the year, three men were elected to mem-
bership in the society, A. W. Mandelstam, M. D.,
Robert Frost, M. D., and Glidden Brooks, M. D.
Three members have died, Joseph O. Marien,
M. D., George B. O’Connell, M. D., and Romeo J.
Morin, M. D.
The present roster includes 69 paid-up members
and two members have been delinquent in their
dues.
At the present time, we have five of our mem-
bers in the service.
FRANKLIN COUNTY
Four meetings of the Franklin County Medical
Society were held last year with a good attendance
at each meeting. On August 24th, the Society held
its annual outing at Clearwater Lake with 55
members and guests present and a shore dinner
being served. The remaining three meetings were
business meetings. Important changes in the fee
schedule were made during the year — the raising
of both office calls and house calls to two and three
dollars respectively.
It was also voted that Verdeil Oberon White,
M. D., of East Dixfleld, a graduate of Harvard
Medical School and licensed in 1892 be recom-
mended to the Maine Medical Association for a
fifty-year medal.
The officers elected at the annual meeting are as
follows: President, James Reed, M. D., Farming-
ton; Vice President, Harry Brinkman, M. D., Wil-
ton; Secretary-Treasurer, Lorrimer Schmidt,
M. D., Strong; Delegate to Maine Medical Associa-
tion, George Pratt, M. D., Farmington; Alternate,
James Reed, M. D., Farmington; Board of Censors,
Maynard Colley, M. D., Wilton, 1942; C. C. Wey-
mouth, M. D., Farmington, 1942; Frank Springer,
M. D., Farmington, 1942.
OXFORD COUNTY
Two regular meetings and one special meeting
were held the past year.
At the regular meeting. May 21, 1941, held at
Bethel Inn, Joseph H. Pratt, M. D., of Boston,
Mass., gave a very interesting paper on “Home
Treatment of Pneumonia with Sulfathiazole” with
a report of 125 cases.
At the special meeting held at Hotel Harris,
September 24, 1941, the application of Homer C.
Lawrence, M. D., Bethel, Maine, was received and
referred to the Councilor.
At the annual meeting held at Bethel Inn, Octo-
ber 21, 1941, the following officers were elected:
President, Albert P. Royal, Jr., M. D., Rumford;
Vice President, Johnson L. Bean, M. D., Norway;
Secretary-Treasurer, J. S. Sturtevant, M. D., Dix-
field.
Auxiliai'y Committee on Legislation — D. M,
Stewart, M. D., South Paris.
Councillors — H. M. Howard, M. D., Rumford;
L. M. Corliss, M. D., West Paris; R. R. Tibbetts,
M. D., Bethel.
Delegates to Maine Medical Association — R. E.
Hubbard, M. D., Waterford; D. E. Elsemore, M, D.,
Dixfleld.
Nineteen Hundred and Forty-two — June
125
Alternates — Walter G. Dixon, M. D., Norway;
J. A. MacDougall, M. D., Rumford.
Homer C. Lawrence, M. D., Bethel, Maine, was
elected to membership.
Bentley Colcock, M. D., from the Lahey Clinic,
Boston, Mass., gave an excellent lecture, his sub-
ject being “Problems in Gynecology.”
Two honorary members.
Thirty-seven regular members, whose dues were
all paid before April 1st. That gave the society a
100% standing for payment of dues.
Eugene M. McCaety, M. D.,
Councilor, Second District.
Report of Councilor, Third District
To the Officers and Members of the Maine Medical
Association :
The combined Lincoln-Sagadahoc County So-
ciety has completed its second year of existence.
The members from the eastern county have con-
tributed a valuable infusion effect. Four meetings
have been held with out-of-state speakers the rule.
One member, A. A. Stott, M. D., of Bath, is in the
Naval Medical Service with rank of Lieutenant
Commander. The excellent local hospital at
Damariscotta has enjoyed a year of activity. The
hospital at Bath is overtaxed for capacity and will
shortly be considerably enlarged. The members of
the Society will consequently be offered new clini-
cal opportunities. It is hoped that increased en-
thusiasm for more frequent medical meetings will
be fostered in order to stimulate interchange of
clinical observations and experiences.
The Knox County Society with twenty-eight
active members has enjoyed a satisfactory year
with average attendance of fourteen at nine meet-
ings. Death has deprived the Society of two
valued members in the persons of F. B. Adams,
M. D., and William Ellingwood, M. D., the latter
of whom was particularly active locally and in the
State Society. Two members, Howard Apollonio,
M. D., and John Kazutow, M. D., are serving with
the armed forces, the former in the Navy, the lat-
ter in the Army. Four members have been lost
by transfer to the newly formed Lincoln-Sagadahoc
Society. The meetings have been stimulating, usu-
ally associated with an afternoon clinic, deserving
larger average attendance than that reported above.
Three members have enjoyed post-graduate study
this year.
Respectfully submitted,
C. Harold Jameson, M. D.,
Councilor, Third District.
Report of Councilor, Fourth District
Your councilor for the Fourth District wishes to
submit the following report:
WALDO COUNTY MEDICAL SOCIETY
They have held six medical meetings during the
last year which would seem to be very good, espe-
cially for a small society.
There have not been any new members taken in.
There have been no men taken into the service
of U. S. A.
SOMERSET COUNTY MEDICAL SOCIETY
They have held two independent medical meet-
ings and one joint meeting. It seems that the
larger proportion of the men are connected with
the Memorial Hospital of Skowhegan, and thus
have given more attention to the Staff meetings of
the hospital.
There have 'been no new members taken in.
There have been no men taken into the service
of the U. S. A. as yet, although I understand there
ai’e several going in shortly.
KENNEBEC COUNTY MEDICAL SOCIETY
There have been eight meetings of this society.
Five new members were taken into the society
and ten men gone into the service of the U. S. A.
We believe that the record of the fourth district
has been good, but would suggest that some of
the staff meetings of the hospital at Skowhegan
be given over to meetings of the Somerset County
Medical Society.
John O. Pipee, M. D.,
Councilor, Fourth District.
Report of C ouncilor. Fifth District
To the Officers and Members of the Maine Medical
Association :
The Hancock County Medical Society has held
a total of eight meetings and one summer clinic
since June 1st of last year. The attendance this
year has been the best that they have enjoyed for
the past eight years. Out of a total membership
of 21 they can now expect from eleven to seven-
teen to be present at each meeting. At the annual
meeting in December the society voted to hold
meetings every month until the present emer-
gency is over. As well as carrying on their regu-
lar society programmes, they have made these
meetings a clearing house for Civilian Defense
problems (of a medical nature) and a planning
board for their defense programme in that county.
Early in January the old Hancock County Dental
Society became rejuvenated, under the impetus
of the present emergency, and since that time
they have been holding their meetings conjointly
with them. The whole thing has worked out well,
and there is more cooperation between the medi-
cal and dental professions there than there has
ever been before.
Last December they found their treasury with a
considerable balance. They used some of that
money to buy four complete plasma transfusion
outfits as a beginning in the establishment of a
plasma bank. Two are now located in Ellsworth
and the other two in Bar Harbor, but available
anywhere in the county in case of need.
It has been a most successful year so far as the
society is concerned.
The Washington County Medical Society during
the past year has held four meetings, one each at
Calais, Robbinston, Machias, and Eastport. The
meetings at Calais and Robbinston were in con-
junction with the St. Croix Medical Society which
includes members of the New Brunswick Medical
Society and were largely attended and addressed
each time by physicians from St. John, N. B.
The excellence of the speakers selected to
address us was shown by the attendance which
has averaged better than 60% of our total
membership.
Three new members were added during the
year.
Respectfully submitted,
Oscar F. Larson, M. D.,
Councilor', Fifth District.
126
Report of Councilor, Sixth District
It is indeed a pleasure to report the healthy
condition of the Sixth Councilor District.
The Penobscot County Medical Association has
a membership of 92. Practically all who are
eligible for membership in the Association are
members. Dues were reported as 100% paid be-
fore April 1st. They held eight meetings this last
year with an average attendance of 46, better than
50% attendance at meetings. The following seven
members were in the service on May 1st:
Captain Herbert T. Clough, Portland, Maine.
Major Lawrence M. Cutler, Army.
Captain I. Francis Gregory, Bangor, Maine.
Lieutenant Commander Havilah E. Hinman,
Navy.
Major Harold E. Pressey, Army.
Lieutenant Benjamin L. Shapero, Army.
Captain Max E. Witte, Army.
It is thus seen that about 8% of the members of
the Penobscot County Medical Association are now
in the service.
The Aroostook County Association has only two
meetings a year. Its membership consists of 39
paid-up members. Two members in service and
three honorary members. Membership was 100%
paid up before April 1st. The average attendance
at meetings is 30, which gives them an average
attendance at meetings of 68%. When we con-
sider the distances some must travel in Aroostook
County to attend a meeting, I think we must
congratulate the Aroostook County Medical Asso-
ciation on such an excellent record. There are,
however, eight doctors in Aroostook County who
are eligible for membership who do not belong to
the Association. This probably is due to the dis-
tances which make it nearly impossible for some
to attend meetings. The two members in service
are George Ebbett, M. D., of Houlton, and Prank
Blossom, M. D., of Caribou. It is thus seen that
about 4% of the members of the Aroostook County
Medical Association are now in the service.
The Piscataquis County Association has a total
membership of only 18. Two are honorary mem-
bers but they have chosen to pay dues in the
County Association. Average attendance at meet-
ings is better than 80%. If guests are included at
its meetings its average attendance is consid-
erably better than 100%. Four regular meetings
are held each year and one special meeting has
been held for several years. Several members of
the Piscataquis County Association are usually
present at the Penobscot County Medical meet-
ings, and at the meeting of the American College
of Surgeons in Portland the last of March six
members from Piscataquis County were present
(33%%). There is but one member in the service
— W. B. S. Thomas, M. D., of Dover-Foxcroft, who
is now a Captain in the U. S. Army. This, how-
ever, gives Piscataquis County a little better than
5% of its membership in the service.
Respectfully submitted,
N. H. Nickerson, M. D.,
Councilor, Sixth District.
The Journal of the Maine Medical Association
Committee Reports
Standing Committees
Public Relations C ommittee
Radio and Press:
Taking the problems of the medical profession
or the hospitals to the radio, the press, or the
rostrum seems to offer many complications and
no solutions. With that in mind this committee
has taken no action and made no recommenda-
tions. There is danger that the public will mis-
interpret our motives; there is certainty that it
will misinterpret our message. The line between
informative lectures or articles and advertising
is yet so indistinct and artful in both press and
radio offerings as to make both those avenues
common and confusing.
The contributions to radio and magazines dur-
ing the current year, on the sulfa drugs alone,
have been so charged with misinformation that no
scientific body can trust them as avenues for
public instruction.
It is felt that problems relating to immunization
of school children and kindred propositions should
be the concern of the legally constituted health
authorities.
Our most effective public service remains, as of
old, prompt, skilful, courteous, faithful attention
to those who are in physical or mental distress.
Legislation:
It is recommended that no State legislation be
sponsored by this Association during this legis-
lative year.
It is recommended that a protest, of such a text
and extent as may be approved by the house of
delegates, be made to our national senators and
representatives against the passage of a bill to
subject all Hospitals, Schools, Colleges and other
endowed institutions to the provisions of the
National Income Tax. Such a bill has been pro-
posed by the Treasury Department.
The War Effort:
It is felt that the medical profession may be
collectively and individually entrusted with the
duties which disaster may bring.
Signed:
R. Bliss, M. D., Chairman,
Henry C. Knowlton, M. D.,
Frederick T. Hill, M. D.,
C. W. Kingiiorn, M. D.
Cancer C ommittee
To the Officers and Members of the Maine Medical
Association :
During the legislative session of 1941, “an act
to promote cancer control” was passed. The pro-
gram is now being carried out. This program was
described in an article by Dr. Kobes and myself
which appeared in the Maine Medical Journal for
April, 1942. A recapitulation seems unnecessary.
I wish to call the attention of the president and
the council of the Maine Medical Association to
certain recommendations made in the report of
1941. I trust that they will give this matter their
consideration and take such action as they deem
to be advisable.
127
Nineteen Hundred and Forty-two — June
The present Cancer Committee consists of six
members, including the chairman. They are:
Dr. Edward H. Risley of Waterville
Dr. Magnus F. Ridlon of Bangor
Dr. Bertrand A. Beliveau of Lewiston
Dr. M. Tieche Shelton of Augusta
Dr. William Holt of Portland
In so far as I know, the committees previously
appointed consisted of five members only.
It seems to me that five members are sufficient,
and as noted in last year’s report, the terms of
office should be staggered so that each member
would have a continuous experience with suffi-
ciently frequent replacements.
Membership in the committee should include
those who are associated with: (1) Tumor clinics,
(2) The Women’s Field Army, (3) The Maine
Hospital Association. There should be included at
least one to represent the Medical Association at
large, preferably a surgeon.
This committee serves as an advisory and con-
sulting board to Dr. Kobes, who is the executive
ofiicer of the state program.
Implementation of the program, as far as actual
care and treatment of cancer is concerned, is
centered in the hospitals. It is, therefore, impera-
tive to have close cooperation and understanding
with and through hospital administrators.
In selecting what may be called members at
large, geographical representation should be con-
sidered as well as representation based on centers
where of necessity complete facilities for diag-
nosis and treatment of cancer are now available.
Mortimer Warren, M. D.,
Chairman, Cancer Committee.
Special Committees
Committee to Investigate Collection
Agencies
From a financial standpoint, the collection
problem is probably one of the most important
matters which confronts the medical profession
today. The doctor, in too many cases, is expected
to make a professional call, send a number of
bills, and then collect his money personally or
employ a collection agency to do it for him. This
seems to be the present day technique. To collect
personally is impractical, and to use a collection
agency, too often, is unsatisfactory. In this report
I shall endeavor to present some of the unfair
practices used by various collection agencies.
There are various kinds of collection agencies
employing many different methods. The first
broad classification would be the so-called “COL-
LECTION CONTRACT AGENCIES.’’ It is my
belief, after some years of observation, that the
Doctor should beware of any company demanding
a signed contract.
Contracts :
I have read a great many Collection Contracts,
and in nearly every instance there has been a
“joker’’ incorporated. Considering the contract of
one large concern, the “joker” is as follows: “The
undersigned further assigns lists of accounts, in-
structs and authorizes the company to investigate,
negotiate, settle, adjust and collect, at the terms
set forth in this contract, any of said accounts
that do not furnish acceptable security, and to act
as attorney in fact with general powers to endorse
for deposit and collection, commercial paper re-
ceived from any account.” One may readily under-
stand that this constitutes a very broad assign-
ment and gives discretionary powers over the
client’s accounts to a third party.
I have before me one contract which states, “As
evidence of good faith, the undersigned client is
now paying to the — — — Company the sum of
$15.00, receipt of which is hereby acknowledged,
and agrees to pay the balance of the service fee
in the sum of $15.00 upon demand, or it may be
retained out of first collections listed with
Company.”
You may see from the above that the sales
representative receives the $15.00. The contract
further states, “Pay the sales representative $15.00
— NO MORE.” This company has special com-
mission rates which actually figure 50 per cent of
claims.
Account Purchase Plan:
This particular company’s salesman first cap-
tures your attention by stating that he has come
to “purchase” your accounts. You are, of course,
interested. He offers a plan whereby 80 per cent
of the undisputed amount of a claim less than
three months overdue will be paid; 70 per cent of
each claim less than nine months overdue and 50
per cent of all other claims. The first “joker” in
this plan is a very broad general assignment
clause. The second “joker” states that the pur-
chase plan will operate, or the claims be returned
in ninety days. You may readily see that the
Company simply “skims the cream” off the ac-
counts in their hands during this 90 days. For the
reader’s interest I would say that I, personally,
had had one such company investigated by a
responsible financial man, and the company in
question had less than $200.00 in its bank account
in its home town. “Enuf sed” relative to this
particular type of contract.
Advance Payment, Yearly Service Contract:
This type of contract operates throughout the
State of Maine. The concern sells a service con-
tract with a number of clauses, one of which is as
follows: “Accounts will be collected without
commission or any other expense.” The contract
sells for a yearly sum, payable in advance, the
sum ranging from $18.00 to $60.00 per year. The
amount charged depends upon the number of ac-
counts which the company expects will be turned
over to it.
The above plan, on the face of it, is impractical
since the company could be literally swamped
with accounts, and in most cases, it cannot collect
for the client much more than the amount paid
for the yearly fee because the company pays its
128
The Journal of the Maine Medical Association
sales representatives 50 per cent of the fee, which
leaves very little for servicing accounts.
Commission Contracts;
We may consider this a rather “tricky” con-
tract whereby the creditor agrees to pay one-third
or 33% per cent of each claim collected, but in
case the company collects any of these claims on
the installment plan, then it is to retain 50 per
cent. Over 90 per cent of all claims given out for
collection are paid on the installment plan, so this
is simply a clever manner by which the company
extracts 50 per cent.
Letter Fees:
There are collection agencies which operate on
a “letter fee” basis, whereby the client agrees to
pay 50 cents per letter. In every case brought to
my attention, the “letter fee” amounted to more
than the amount collected.
Withdrawn Claims:
Most of these contracts have a clause whereby
the company charges 50 per cent of all claims
withdrawn or cancelled during the process of col-
lection. If the company is dishonest, it can simply
hold up your funds and reports until such time
as you lose patience and demand the return of
your accounts. They have been known to then
charge 50 per cent of the total list, which would
leave the doctor owing them a considerable sum
of money, and they would retain all they had col-
lected and, possibly, sue for any balance due them.
Personal Calls:
I must refer briefly to the salesman who states
that he will make “personal” calls on all debtors.
In my opinion, no organization or individual
handling doctors’ claims can make personal col-
lection calls on all debtors. It is impossible for
one to do so. If the company or individual does
enough business to make a living, they cannot
possibly make enough collection calls to propeMy
handle the accounts. They, of necessity, must
simply collect the easy ones, and return the slow
or difficult accounts, which, normally, would pay
50 cents or one dollar per week. I, personally,
believe that “personal call collectors” are very
unsatisfactory.
In my thirty years of practice I have found very
few collection agencies which have proven satis-
factory and have given good results. One company
gives me monthly settlements with a meticulous
record of collections made, and 1 have never had
any unhappy sequelae. I also know of only one
lawyer who has been active and efficient in this
work. Undoubtedly, there are others, but I just
didn’t meet up with them.
In conclusion, I would ask every doctor to con-
sider this advice and warning. “DON’T send your
accounts out of the State, for the following
reasons :
First — You would not give a stranger a sum of
money, why give one your valuable ac-
counts?
Second — In most cases you know nothing of the
financial responsibility of the company in
question.
Third — It will be very difficult and expensive to
try to prosecute any agency in another State,
for embezzlement, if such occurred.
Fourth — There are reputable and financially re-
sponsible Agencies in this State which can
handle your accounts.
Fifth — Choose your Collection Agency as you
choose your Bank, through its financial re-
sponsibility, reputation and years of
standing.”
Watch your step! Ask! Investigate first!
Adam P. Leighton, M. D.,
Committee.
Committee on Graduate Education
To the Officers ayid Members of the Maine Medical
Association:
The Committee on Graduate Education submits
the following report for the year 1941-42:
The program of Graduate Medical Education
throughout the country has been seriously affected
by the National Emergency. This became mani-
fest during the months preceding the Declaration
of War, when it was obvious that we were enter-
ing a period calling for increased sacrifices and
the acceptance of lowered standards in many
ways. This has meant the giving up or curtailing
of many postgraduate assemblies and a drastic
reduction in formal postgraduate courses. There
is a very subtle danger that we may begin accept-
ing lowered standards in many ways which should
not be necessary. The complete abandonment of
the Graduate Education program would be most
detrimental to Medicine.
It has been customary to use the terms Gradu-
ate Education and Continuation Education inter-
changeably, as referring to one and the same
thing. Actually there has been a difference.
Graduate Education has applied rather to the
formal postgraduate courses and the Assemblies
held under the auspices of the several State Medi-
cal Societies. Continuation Education, on the
other hand, might better refer to the more or less
informal teaching programs carried on at regular
intervals through the medium of the County Soci-
ety and the Hospital Staff meetings. If this differ-
entiation be accepted we may forego, for the Dura-
tion, the formal programs of Graduate Education;
and, by concentrating upon, and further develop-
ing, a program of Continuation Education, help
maintain a high standard of professional service.
For a number of years the Bingham Associates
and the Commonwealth Fund have provided Fel-
lowships for postgraduate courses for members of
the Maine Medical Association. This has enabled
us to meet the problem of Graduate Education for
the rural practitioner in a way which otherwise
would have been difficult of solution. But with the
eventual Calling to the Colors of most of our
younger physicians, and the consequent added
responsibility of those left at home for the care
of the civilian population, an abandonment of this
plan is inevitable. Last year 51 Maine physicians
took courses through the Bingham Associates and
four through the Commonwealth Fund, a reduc-
tion of approximately 33%. After this fall it is
extremely doubtful if further Fellowships will be
available.
Your committee has felt for some time that Con-
tinuation Education, if properly developed, could
be productive of the greatest good to the greatest
number. A previous survey had indicated that a
majority of our physicians regularly attended hos-
pital staff meetings. We felt that these hospital
meetings together with the County Society meet-
ings were the most fertile field for the develop-
ment of the Continuation program.
The County meetings have been greatly im-
proved. Practically all of the County Societies now
Nineteen Hundred and Forty-two — June
conduct programs of good teaching value, although
some county societies hold too few meetings and
at irregular intervals. Monthly meetings on stated
dates with programs prepared well in advance
are highly desirable.
Realizing the opportunity for developing Con-
tinuation Education through the hospital staff
meeting, an effort has been made to evaluate the
character of the staff meetings of our hospitals.
Last year a survey of the hospitals of the State
indicated that 22 of these were endeavoring to
furnish programs of teaching value. Twenty-four
hospitals were holding monthly meetings, except
for July and August, while one hospital held bi-
monthly, and one, weekly meetings. This year a
questionnaire was sent to every hospital having
an organized staff. Replies were received from 19
as follows: Webber Hospital, Biddeford; Goodall
Hospital, Sanford; Children’s Hospital and State
Street Hospital, Portland; Rumford Hospital,
Rumford; Central Maine, St. Marie’s, Lewiston;
Franklin Hospital, Farmington; Augusta Hos-
pital, Augusta; Camden Hospital, Camden; Knox
Hospital, Rockland; St. Andrew’s Hospital, Booth-
bay Harbor; Cary Hospital, Caribou; Waldo Hos-
pital, Belfast; Mt. Desert Hospital, Bar Harbor;
Eastern Maine Hospital, Bangor; Dean Hospital,
Greenville; Sisters and Thayer Hospitals, Water-
ville.
While it is regretted that so many hospitals
ignored the questionnaire, it is felt that those
returned gave valuable information. These were
subjected to a more critical study, based upon
impartial personal observations insofar as pos-
sible. This indicated that the teaching program
was good in 14, fair in 3 and poor in 2. The at-
tendance was good in 11, fair in 6 and poor in 2.
Three hospitals had a good percentage of staff
members attending national meetings and taking
postgraduate work. Six hospitals rated fair in this
respect and 10 poor. It is encouraging to note
that several hospitals, hithertofore doing little by
way of a teaching program, are now earnestly
striving to improve in this respect. Two hospitals,
129
because of their size and location, deserve espe-
cial mention, St. Andrew’s in Boothbay Harbor
and Dean in Greenville.
Recommendations :
The committee recommends that all County
Societies hold monthly meetings on regular stated
dates with carefully selected programs of teach-
ing value. The committee is ready to assist
County Officers in providing such programs.
The committee recommends the adoption of the
teaching type of hospital staff meeting, based
upon studies of hospital cases. It urges more fre-
quent meetings with carefully prepared programs.
With the necessary curtailment of the Graduate
Program, Continuation Education in the County
Society and in the staff meeting assumes a greater
importance and must be further developed if we
are to maintain high standards of medical service.
James Carswell, Jr., M. D.,
Thomas A. Foster, M, D.,
Julius Gottlieb, M. D.,
Eugene E. Holt, Jr., M. D.,
Frank H. Jackson, M. D.,
LeRoy H. Smith, M. D.,
Frederick T. Hill, M. D., Chairman.
Committee to Survey Hospital and
Medical Care
Pressure is being renewed in Washington for
compulsory health insurance. Your attention is
called to the proposals of Altemyer and Falk of
the Social Security Board.
Your committee believes that the present emer-
gency is not the time for the Medical Profession
to relax its vigilance. A detailed report of develop-
ments in prepaid medical care is in preparation
for presentation to the House of Delegates at the
Annual June Meeting.
S. J. Beach, M. D.,
Chairman.
Itt Mtmxivmm
hmaaeh ainrr iSlay 31, 1941
Adams, Frederick B.,
Rockland
Anderson, William D.,
Portland
Cox, James F.,
Bangor
Dunn, Bertrand F.,
Portland
Ellingwood, William A.,
Rockland
Hagerthy, Albert B.,
Ashland
Hendee, Walter W.,
Vassalboro
Hutchins, Guy H.,
Auburn
Ilsley, Harris P.,
Limington
MacDougal, William A.,
Westfield
Marien, Joseph 0.,
Lewiston
Merrill, Earl S.,
Bangor
Morin, Romeo J.,
Lewiston
O’Connell, George B.,
Lewiston
Sylvester, Charles B.,
Portland
Tozier, Frank L.,
Fairfield
130
The Journal of the Maine Medical Association
Report of the Secretary-Treasurer
Secretary’s Report
To the Members of the Maine Medical Association:
As your Secretary I am pleased to submit the
following report.
There are 741 members in the Association: 667
active, 47 in Military Service, and 27 honorary.
Thirty-nine members have been added to our roster
during the past year, and nine have been reinstated
to membership. We have lost fifteen members by
death. Thirteen have been suspeirded for non-
payment of dues in accordance with our By-Laws,
Chapter VIII, Section I. One member has retired
and resigned from membership, six have moved
out of the State, and one whose license has been
revoked has been dropped from our roster.
100% payment of dues has been received from
the following County Societies: Aroostook, Frank-
lin, Hancock, Knox, Lincoln-Sagadahoc, Oxford,
Penobscot, Piscataquis, Waldo, and Washington. I
wish to express my appreciation to the members
of these Societies for their prompt payment of
dues, which not only helps their County Secretary
but facilitates the work of the State Association.
The 1941 clinical session held at Portland, Thurs-
day and Friday, October 16th and 17th, has gone
down on our records as a complete success. A total
of 188 members registered during the two-day
session and attended clinical programs at the
Maine General Hospital, Maine Eye and Ear
Infirmary, Queen’s Hospital, and State Street
Hospital. Walter E. Tobie, M. D., of Portland,
spoke on An Old-Fashioned Medical School at the
dinner meeting Thursday evening. Over 175 mem-
bers and guests attended this meeting and enjoyed
Doctor Tobie’s excellent portrayal of the Bowdoin
Medical School of 1897-99, and the photographs of
classrooms and students which followed. Guest
speaker, C. Guy Lane, M. D., of Boston, spoke on
Occupational Dermatosis, at the Maine General
Hospital on Friday afternoon, following which the
meeting was adjourned.
The 90th annual session will be held at the
Poland Spring House, Poland Spring, Maine, June
21st, 22nd, and 23rd. The program, to be found
elsewhere in this issue, has been arranged by the
Scientific Committee, of which Currier C. Wey-
mouth, M. D., of Farmington, is Chairman. I am
not going to elaborate on the excellence of this
program, which speaks so well for itself.
The Council report for the year will be presented
by the Chairman, Stephen A. Cobb, M. D., of San-
ford, at the first Meeting of the House of Delegates
on Sunday, June 21st, at 4.30 P. M. Election of the
President-elect will take place on Monday, June
22nd, at 5.00 P. M., followed by the Second Meeting
of the House of Delegates at 5.30. All members
are invited and urged to attend the meeting of the
House of Delegates.
The Association’s Fifty-Year Medals will be pre-
sented at the dinner Monday evening to: Clayton
H. Bayard, James P. Blake, Luther G. Bunker,
Ralph H. Marsh, Edward F. Robinson, Owen Smith,
Eugene L. Stevens, Frederick E. Wheet, and
Verdeil 0. White. The Association is proud to have
these members still in the ranks, and is privileged
to present them with this medal, a symbol of the
high regard in which we hold them.
The Commercial Exhibits are listed in the Pro-
gram Section of this issue, each with a descriptive
paragi’aph explanatory of their exhibit. Look them
over and you will find many old friends and a
few new. Make a resolve right now to visit each
exhibit and show your appreciation for the loyalty
these firms are showing in being with us this year.
Our President and Editor have both stressed the
importance of this year’s meeting. The Scientific
Committee have spent much time and effort in
arranging the program, which promises much of
value to all of us in these critical times. I can
only add that I hope you will all make a special
effort to attend some or all of the sessions.
In closing, I wish to express my appreciation to
the County Secretaries, Councilors, and other
Officers of the Association for their cooperation
during the past year. Also to the members who
have helped to make this year a real success.
Respectfully submitted,
Frederick R. Carter, M. D.,
Secretary.
May 31, 1942.
Treasurer’s Report
To the Members of the Maine Medical Association :
As your Treasurer I am pleased to submit the
following report.
The books of the Association and Journal were
closed and audited as of May 31, 1942, by Jordan
and Jordan, Accountants and Auditors, who have
“found the same complete and correct in all details
of record.” To conserve space, we are printing
only a portion of the Auditor’s Report, which
follows. A copy of the complete report, which
contains, in addition to the following, statements
of Capital Account, Trust Investments and Funds,
and Securities and Bonds, has been sent to each
member of the Financial Advisory Committee and
is on file in the Portland office, where it is available
to any member of the Association.
Respectfully submitted,
Frederick R. Carter, M. D.,
Treasurer.
May 31, 1942.
(From the Statement drawn up by Jordan &
Jordan, Accountants and Auditors, to “show the
true financial position of the Association May 31,
1942.”)
Balance Sheet, May 31, 1942
ASSETS
Cash in Banks $14,921.73
Accounts Receivable — Sundry 375.00
Dues Receivable 120.00
Advertising Receivable 322.19
Securities 7,005.00
Furnishings and Equipment .... 1,092.59
Impounded Cash 1,504.05
Annual Meeting Expense — De-
ferred 1.20
$25,341.76
Trust Fund Investments 2,238.93
Total Assets $27,580.69
LIABILITIES, CAPITAL AND TRUST FUNDS
1942 Exhibit Space Deferred ....$ 595.50
Capital Account 24,746.26
$25,341.76
Trust Funds 2,238.93
Total Liabilities, Capital
and Trust Funds $27,580.69
Continued on page HO
Pnoa/ia*n
90tk ANNUAL 8E8SION
MAINE MEDI6AL A8806IATI0N
JUNE 21, 22, 23, 19^2
NOLAND SPRINg HOUSE
TOLAND SPRINg, MAINE
PROgRAM ARRANgED
BY THE
56IENTIFIG 60MIMTTEE
GURRIER G. WEYMOUTH
Gkaicman
132
The Journal of the Maine Medical Association
TVfembecs
8GIENTIFIG COMMITTEE
EUgENE E. O’DONNELL
FORREST B. AMES
ROLAND L. McKAY
FREDERIGK R. CARTER, Secretary
Nineteen Hundred and Forty-two — June
133
INFORMATION
Registration :
Registration headquarters will be in the Lobby
of the Poland Spring House. Every member and
guest is requested to register and receive a badge
on arrival.
Emergency Calls:
All emergency calls will be given prompt atten-
tion. If expecting a call leave your name and
where you can be located with the Association
registrar.
Motor Travel to Poland Spring:
See “Communication from Secretary’s Office
Relative to Gasoline Rationing and Motor Travel
to Poland Spring Convention,” in Special Notices
following Program.
Procurement and Assignment Service:
Brig. Gen. John G. Towne, M. C., of Waterville,
Chairman for the State Medical Committee of Pro-
curement and Assignment Service, will be pres-
ent, during the entire session, to answer questions
relative to the Service.
Papers :
All papers read before this Association shall be
its property for publication in The Journal of
THE Maine Medical Association, and when read
shall be deposited with the Secretary.
SUNDAY, JUNE 21, 1942
4.30 P. M.
First Meeting of the House of Delegates.
7.00 P. M.
Dinner.
8.30 P. M.
Guest Speaker, Reverend George W. Shepherd,
Boston
Subject: The Battle for Freedom in China and
India.
The Reverend Mr. Shepherd has lived for more
than twenty years in China. For the past
few years, while in China, he has been per-
sonal economic advisor for Generalissimo
Chiang-Kai Shek.
MONDAY, JUNE 22, 1942
Morning Session
9.00 A. M.-9.30 A. M.
General Assembly,
President P. L. B. Ebbett, presiding
Invocation,
Rev. Benjamin B. Hersey, Portland
Announcements,
Currier C. Weymouth, M. D., Chairman,
Scientific Committee
Frederick R. Carter, M. D., Secretary
9.30 A. M.-12.00 M.
Conferences
I
Traumatic Surgery
Chairman: William V. Cox, M. D.,
Auburn
1. Treatment of Compound Fractures in War
Time,
Morris Goldman, M. D., Lewiston
2. Treatment of Burns,
Harry Brinkman, M. D., Farmington
3. The Use of Sulfa Drugs in Traumatic
Surgery,
Francis WInchenbach, M. D., Bath
4. Neurosurgical Problems of Warfare,
William V. Cox, M. D., Lewiston
II
Clinico-Pathological
Chairman: Theodore E. Hardy, M. D.,
Waterville
Co-Chairman: Julius Gottlieb, M. D.,
Lewiston
Conducted by: Howard T. Karsner, M. D., Director
of the Institute of Pathology, Western Re-
serve University, Cleveland Ohio.
Subject: Cases Presenting Vascular Lesions
Clinical Presentations,
Charles W. Steele, M. D., Lewiston
Pathological Introduction,
Julius Gottlieb, M. D., Lewiston
Kodachrome films of pathological specimens
will be presented.
III
Obstetrical and Gynecological
Chairman: Magnus RIdlon, M. D.,
Bangor
1. Endometriosis,
Walter F. W. Hay, M. D,, Portland
2. The After-coming Head as an Obstetrical
Problem,
K. Alexander Laughlin, M. D., Portland
3. Toxemias of Pregnancy,
Clarence Emery, Jr., M. D., Bangor
IV
Oto-Laryngological-Pediatric
Chairman: Pierre E. Provost, M. D.,
Augusta
Co-Chairman: Maurice E. Priest, M. D.,
Augusta
1. Acute Laryngotracheobronchitis.
Otolaryngological Aspect,
George O. Cummings, M. D., Portland
Pediatric Aspect,
Albert W. Fellows, M. D., Bangor
2. Influence of Tonsillectomy and Adenoidec-
tomy on Children.
Otolaryngological Aspect,
Henry P. Johnson, M. D., Portland
Pediatric Aspect,
Thomas A. Foster, M. D,, Portland
3. Complications of Acute Infectious Diseases.
Pediatric Aspect,
Edwin H. Place, M. D., Boston, Mass.
Otolaryngological Aspect,
Frederick T. Hill, M. D., Waterville
134
The Journal of the Maine Medical Association
V
Tuberculosis
Chairman: Edward A. Greco, M. D.,
Portland
1. The Influence Surgery Has Had in Tuber-
culosis,
Charles D. Cromwell, M. D., Fairfield
2. Diagnosis and Treatment of the Out-
Patient,
• S. David Daniels, M. D., Hebron
Luncheon
12.30 P. M.
Tables will be reserved for reunions of alumni of
Boston University, Johns Hopkins, Bowdoin,
McGill, Vermont, Tufts, Yale and Harvard
Medical Schools, and members of the Tumor
Clinics.
Afternoon Session
2.00-4.45 P. M.
Scientific Session
1. Introduction of Visiting Delegates.
2. Endometriosis; Its Etiology, Symptoms and
Treatment.
Joe Vincent Meigs, M. D., Boston
Discussion opened by Adam P. Leighton,
M. D., Portland
2. Aortic Stenosis, Cause and Manifestations,
Howard T. Karsner, M. D., Professor of
Pathology, Western Reserve University,
Cleveland, Ohio
Discussion opened by Julius Gottlieb, M. D.,
Lewiston
4. Observations on Reversible Heart Disease,
Merrill Sosman, M. D., Professor of
Roentgenology, Harvard Medical School,
Boston, Mass.
Discussion opened by Langdon Thaxter,
M. D., Portland
5.00 P. M.
Election of President-elect.
5.30 P. M.
Second Meeting of the House of Delegates.
Evening Session
7.00 P. M.
Dinner (Dress Informal)
Presentation of Fifty-Year Medals by Presi-
dent P. L. B. Ebbett.
Guest Speaker, Philip D. Wilson, M. D., Professor
Orthopedic Surgery, Columbia University
Medical School; Surgeon-in-Chief, Hospital
for Ruptured and Crippled Children, New
York City
Subject: Surgical War Experiences in England
Doctor Wilson, who has recently returned from
one of several trips to England during the past
two years, will talk chiefly about the treatment
of air raid casualties and al)out the work of the
American Hospital in Britain. He plans to show
lantern slides as well as a motion picture film.
President’s Reception.
Dancing.
TUESDAY, JUNE 23, 1942
Morning Session
9.30 A. M.-12.00 M.
Conferences
I
Annual Meeting of the Maine Medico-Legal
Society
President: William Holt, M. D.,
Portland, presiding
1. Business Meeting
2. Discussion of Legal Angles of Medical Exami-
ner System,
Introduced by Franz U. Burkett, Former
Attorney General, Portland
Discussion by Attorney General Frank I.
Cowan; Chief of State Police, Henry P.
Weaver; County Attorney, Cumberland
County, Albert Knudsen; County Attor-
ney, Franklin County, Benjamin Butler
3. Medico-Legal Aspects of Coronary Occlusion,
Joseph E. Porter, M. D., Associate Patholo-
gist, Maine General Hospital, Portland
4. Forensic Pathology,
Alan Moritz, M. D., Professor, Legal Medi-
cine, Harvard University
II
Surgery
Chairman: Isaac M. Webber, M. D,,
Portland
1. The Use of Blood Substitutes,
Joseph E. Porter, M. D., Portland
2. The Use of Sulfonamides in the Peritoneal
Cavity,
Stephen A. Cobb, M. D., Sanford
3. Sulfonamides in the Treatment of Soft
Tissue Lesions,
Dexter E. Elsemore, M. D., Dixfield
4. Sulfonamide Therapy in Pelvic Conditions
of Women,
Magnus Ridlon, M. D., Bangor
5. The Use of Sulfonamide Drugs in the
Urinary Tract,
C. H arold Jameson, M. D., Rockland
6. Selection of a Sulfonamide and Its Proper
Use,
Hirsh Sulkowitch, M. D., Portland
III
Public Health
Chairman: Roscoe L. Mitchell, M. D.,
Augusta
1. Brief History of Anti-T. B. Developments
in Maine,
Lester Adams, M. D., Hebron
2. Early Diagnosis — Responsibility of General
Practitioner,
L. H. Smith, M. D., Winterport
3. Modern Treatment,
George E. Young, M. D., Skowhegan
4. Meeting State Department of Health Re-
sponsibility in Tuberculosis Control,
Alton S. Pope, M. D., Massachusetts
State Department of Health
Discussion opened by Estes Nichols, M. D.,
Portland. All physicians in attendance
are invited to participate in the discus-
sion and to present questions of interest
to them.
Nineteen Hundred and Forty-two — June
135
IV
Fractures
Chairman: Allan Woodcock, M. D.,
Bangor
1. Problem Fractures,
Thomas A. Martin, M. D., Portland
2. Fracture Problems,
Samuel S. Silsby, M. D., Bangor
3. Fractures of the Lower End of the Radius,
Frank H. Jackson, M. D., Houlton
4. Fractures that May be Missed,
Carleton H. Rand, M. D., Lewiston
V
Medical
Chairman: Blynn O. Goodrich, M. D.,
Waterville
Subject: Syphilis
1. History,
Storer W. Boone, M. D., Presque Isle
2. Medicine,
James A. MacDougal, M. D., Rumford
3. Surgery,
M. Tieche Shelton, M. D., Augusta
4. Eye, Ear, Nose,
S. Judd Beach, M. D,, Portland
5. Gynecology and Obstetrics,
Clarence Emery, Jr,, M. D., Bangor
6. Nervous and Mental,
Forrest C. Tyson, M. D., Augusta
7. Public Health,
R. A. Vonderlehr, M. D., Washington, D. C.
8. General Treatment,
Benjamin B. Foster, M. D., Portland
9. The Intensive Arsenotherapy of Syphilis,
Bernard I. Kaplan, M. D., Sing Sing Prison
Hospital Staff
Luncheon
12.30 P. M.
Tables will be reserved for Past Presidents and
County Secretaries.
Afternoon Session
2.00-5.00 P. M.
Scientific Session
1. President’s Address,
P. L. B. Ebbett, M. D,, Houlton
2. Disability Valuations,
Henry H. Kessler, Lieutenant Commander
(M, C.) U. S. N. R. ; Member Council of
Industrial Health, American Medical Assn.
Discussion opened by Stephen A. Cobb,
M. D., Sanford
3. Surgery of the Sympathetic System,
S. C. Harvey, M. D., Professor of Surgery,
Yale University, Surgeon-in-Chief, New
Haven Hospital
Discussion opened by H. Eugene Macdonald,
M. D., Portland
4. The Importance of Searching for Curable
Disease,
Chester Keefer, M. D,, Professor of Medi-
cine, Boston University School of Medicine,
Boston
Discussion opened by Eugene H. Drake,
Lieutenant Commander (M. C.) U. S. N.
5. Medical Services in Civilian Defense,
Colonel Dudley A. Reekie, Chief Medical
Officer of Civilian Defense for the New Eng-
land Area; Allan Craig, M. D., Medical
Director for the State of Maine
Evening Session
7.00 P. M.
Annual Dinner (Dress Informal).
Guest Speaker, Morris Fishbein, M. D., Editor,
The Journal of the American Medical Associ-
ation, Chicago
Subject: Medicine and the War.
Special Notices
Communication from Secretary's Office Relative to Gasoline
Rationing and Motor Travel to Poland Spring Convention
OFFICE OF PRICE ADMINISTRATION
151 Water Street
Augusta, Maine
Edward C. Moran, Jr.
State Director
May 22, 1942
Frederick R. Carter, M. D.
Secretary — Maine Medical Association
State Hospital
Augusta, Maine
Dear Dr. Carter:
You have advised us that the Maine Medical Association will hold its annual meeting on June 21,
22, and 23, at Poland Spring. The meeting is educational in character. Is it proper for doctors to use
their automobiles in attending the meeting under the “X” card?
In our opinion the answer is yes. I would point out, however, that to be within the full spirit of
the rationing program, the doctors should not make unnecessary use of their automobiles to attend the
meeting. If other means of transportation are available, or if by doubling up,, the use of gasoline may
be curtailed, the doctors should be encouraged to act accordingly.
Very truly yours,
(Signed) Robert B, Williamson,
State Attorney.
(over)
136
The Journal of the Maine Medical Association
OFFICE OF PRICE ADMINISTRATION
151 Water Street
Augusta, Maine
Edward C. Moran, Jr.
State Director
Telephone 520
Frederick R. Carter, M. D.
Secretary — Maine Medical Association
State Hospital
Augusta, Maine
Dear Dr. Carter:
The OtRce of Price Administration will appreciate it if in notifying your members with respect to
the use of “X” cards for the Poland Spring meeting, you will, at the same time, remind your members
that all, or substantially all, of the use of a motor vehicle with an “X” card must be for the purpose of
making professional calls or rendering medical services.
Very truly yours,
(Signed) Robert B. Williamson,
State Attorney.
Program for the Ladies!
Golf Tournament, 1942
In reply refer to;
6R;l:b:RBW
May 27, 1942
The Association will hold its fifth annual golf
tournament on the beautiful Poland Spring course.
Now more than ever medical men need diversion
and relaxation from hard and close application to
medical problems. As many as possible should
enter the tournament, and return score cards,
properly attested.
There will be two events, one gross, the other a
handicap affair. Players should enter both, and in
competing should select their own handicap to
bring their net score to a secret number between
par 71 and bogy at 81. This method, in the absence
of classes of players, has worked out very satis-
factorily especially in regard to prizes. The cham-
pionship will be decided on the lowest gross score
submitted. There will be five net prizes.
Before beginning play in the tournament post
your name and handicap with starter. U. S. G. A.
rules will govern except where modified by local
rules. A player may enter both events by playing
one round of eighteen holes and having score card
turned in to the chairman of the committee. Tour-
nament will be played on Monday and Tuesday,
June 22nd and 23rd.
Fifty-Year Service Medals
Fifty-Year Service Medals will be presented at
the dinner Monday evening to the following
members:
Cumberland County Medical Society
James P. Blake, M. D., Harrison, Bowdoin,
1892.
Edward F. Robinson, M. D., Falmouth, Dart-
mouth, 1892.
Owen Smith, M. D., Portland, Bowdoin, 1892.
Frederick E. Wheet, M. D., Westbrook, Uni-
versity of New York City, 1892.
Franklin County Medical Society
Verdeil O. White, M. D., East Dixfield, Har-
vard, 1892.
Kennebec County Medical Society
Luther G. Bunker, M. D., Waterville, Bow-
doin, 1892.
Penobscot County Medical Society
Clayton H. Bayard, M. D., Orono, Physicians
and Surgeons, Baltimore, 1892.
Piscataquis County Medical Society
Ralph H. Marsh, M. D., Guilford, Bowdoin,
1893.
Waldo County Medical Society
Eugene L. Stevens, M. D., Belfast, Bowdoin,
1892.
Registration headquarters will be in the Lobby
at the Poland Spring House. Please register and
receive a badge on arrival.
Mrs. P. L. B. Ebbett of Houlton, and Mrs. Carl
H. Stevens, of Belfast, will be in charge of your
entertainment.
Mrs. Fred B. Hall, Jr., Home Furnishing Advisor
for Porteous, Mitchell and Braun Company, Port-
land, will speak to you on Monday afternoon, June
22nd, at 2.30 P. M. Her subject will be Color
Harmony.
The annual bridge tea v/ill be held at the Hotel
on Tuesday afternoon; time and place to be an-
nounced on the Bulletin Board.
Details of the evening programs will be found
in the Program published in this issue.
Golf, tennis, and the Beach Club will be avail-
able to those interested.
C onvention Rates
The following room rates, which include all
meals, will prevail:
Single rooms without bath $6.00 per day
Double rooms without bath, per per-
son $6.00 per day
Double room and single room with
connecting bath, for 3 persons,
per person $7.00 per day
Two double rooms with connecting
bath for 4 persons, per person ....$7.00 per day
Double room with bath for 2 persons,
per person $7.00 per day
Single room with bath, per person $8.00 per day
The charge for non-registered guests for meals
will be as follows:
Breakfast
$1.00
Luncheon
$2.00
Dinner
$2.50
Golf green fees will be $1.00 per day. The tennis
courts and Beach Club will be available without
charge.
The Hotel Orchestra will he available four hours
each day for dancing.
For reservations write the Poland Spring House,
Poland Spring, Maine.
Make Your Reservations Today
Nineteen Hundred and Forty-two — June
137
Official Delegates, 1942
State Medical Societies
Connecticut
Stanley B. Weld, M. D„ 179 Allyn Street,
Hartford.
Orville F. Rogers, M. D., 109 College Street,
New Haven.
Massachusetts
Warren H. Sherman, M. D., 9 Central Street,
Lowell.
Carleton W. Bullard, M. D., 194 High Street,
Newburyport.
New Hampshire
L. T. Togus, M. D., Manchester.
L. R. Hazzard, M. D., Portsmouth.
Rhode Island
Henry B. Moor, M. D., 147 Angell Street,
Providence.
Carl D. Sawyer, M. D., 182 Waterman Street,
Providence.
Vermont
Samuel Rogers, M. D., Stowe.
County Medical Societies
Androscoggin
Ralph A. Goodwin, M. D., Auburn.
Horace L. Gauvreau, M. D., Lewiston.
Merrill S. F. Greene, M. D., Lewiston.
Alternates :
Otis B. Tibbetts, M. D., Auburn.
William H. Chaffers, M. D., Lewiston.
Albert W. Plummer, M. D., Lisbon Falls.
Aroostook
Harold E. Small, M. D., Fort Fairfield.
Thomas G. Harvey, M. D., Mars Hill.
Alternates :
Herrick C. Kimball, M. D., Port Fairfield.
Gerald H. Donahue, M. D., Presque Isle.
Cumberland
Thomas A. Poster, M. D., Portland.
Prank A. Smith, M. D., Westbrook.
DePorest Weeks, M. D., Portland.
Elton R. Blaisdell, M. D., Portland.
Philip H. McCrum, M. D., Portland.
Clyde E. Richardson, M. D., Brunswick.
Richard S. Hawkes, M. D., Portland.
Alternates :
Edward A. Greco, M. D., Portland.
Louis L. Hills, M. D., Westbrook.
Alvin E. Ottum, M. D., Portland.
Francis W. Hanlon, M. D., Portland.
Franklin
George L. Pratt, M. D., Farmington.
Alternate :
James W. Reed, M. D., Farmington.
Hancock
Raymond E. Weymouth, M. D., Bar Harbor.
Alternate :
Marcus A. Torrey, M. D., Ellsworth.
Kennebec
Leon D. Herring, M. D., Winthrop.
Blynn O. Goodrich, M. D., Waterville.
Ivan E. McLaughlin, M. D., Gardiner.
Frank B. Bull, M. D., Gardiner,
Alternate :
M, Tieche Shelton, M. D., Augusta.
Knox
C. Harold Jameson, M. D., Rockland.
Frederick Dennison, M. D., Thomaston.
Alternates :
Abbott J. Fuller, M. D., Pemaquid.
James Carswell, M. D., Camden.
Linco In-Sagadahoc
Virginia C. Hamilton, M. D., Bath.
Oxfo rd
Roswell E. Hubbard, M. D., Waterford.
Dexter E. Elsemore, M. D., Dixfield.
Alternates :
Walter G. Dixon, M. D., Norway.
James A. MacDougall, M. D., Rumford.
Penobscot
Forrest B. Ames, M. D., Bangor.
Henry C. Knowlton, M. D., Bangor.
Ernest T. Young, M. D., Millinocket.
Frank D. Weymouth, M. D., Brewer.
Alternates :
Arthur C. Strout, M. D., Dexter.
Martin C. Maddan, M. D., Old Town.
Herbert E. Thompson, M. D., Bangor.
Carl E. Blaisdell, M. D., Bangor.
Piscataquis
Harvey C. Bundy, M. D., Milo.
Alternate :
Nathaniel H. Crosby, M. D., Milo.
Somerset
Allan J. Stinchfield, M. D., Skowhegan.
Alternate:
Franklin P. Ball, M. D., Bingham.
Waldo
Raymond L. Torrey, M. D., Searsport.
Alternate :
Foster C. Small, M. D., Belfast.
Washington
Norman E. Cobb, M. D., Calais.
Alternate :
James C. Bates, M. D., Eastport.
York
Edward M. Cook, M. D., York Harbor.
Waldron L. Morse, M. D., Springvale.
Janies H. MacDonald, M. D., Kennebunk.
Alternates :
Carl E. Richards, M. D., Alfred.
Paul S. Hill, Jr., M. D., Saco.
Charles W. Kinghorn, M. D., Kittery.
Association Delegates to 1942
Annual Sessions
American Medical Association
Thomas A. Foster, M. D., Portland.
Connecticut State Medical Society
Neil A. Fogg, M. D., Rockland.
Massachusetts Medical Society
Forrest B. Ames, M. D., Bangor.
New Hampshire Medical Society
Carl E. Richards, M. D., Alfred.
Rhode Island Medical Society
Joseph E. Porter, M. D., Portland.
Vermont State Medical Society (1941)
Harry Butler, M. D., Bangor,
138
The Journal of the Maine Medical Association
Commercial Exhibits at Ninetieth Annual Session
Artra Cosmetics, Inc., 12 Roosevelt Avenue,
Bloomfield, New Jersey.
Artra Cosmetics, Inc., will exhibit Sutra, the
American Medical Association accepted sunfilter
cream. Sutra is an easily absorbed cream — a
shield against painful sunburn, blistering and peel-
ing. Imra, the modern odorless and painless cos-
metic depilatory which involves a new chemical
principle in scientific depilation will also he shown.
At the same booth the Union Pharmaceutical Co.,
Inc., will display Saraka, a diet-aid for use in
common constipation. Saraka consists of bassorin,
a vegetable bulk-producing substance, and fran-
gula, a mild activator, and is particularly effective
in treating all cases of constipation due to lack of
bulk in diets.
The Acousticon Institute of Portland, 690 Congress
Street, Portland, Maine.
The Acousticon Institute of Portland announces
that it will show and demonstrate the new Sym-
phonic, Radio Amplified, Acousticon Hearing Aid,
at the Maine Medical Association Convention,
Poland Spring, June 21, 22, 23.
You are cordially invited to call at our exhibit
and examine this new instrument.
Acousticon — 40 Years’ Uninterrupted Service
to the Deafened. Offices in all the principal cities
of the United States and Canada.
Elmer N. Blackwell, 207 Strand Building, Portland,
Maine.
Surgical Apj^Uances ExMMl.
Supporting Belts, Trusses, Arches, Women’s Cor-
set Supports, and Elastic Hosiery, are now helping
more men and women to keep physically fit, and
keep them working. You can profit by visiting our
exhibit this year, and ask Mr. Blackwell about the
many supporting appliances available for your pa-
tients. Don’t pass up the opportunities again this
year. Our 20 years of experience can help you
with your problems of support for men, women
and children. At the BLACKWELL EXHIBIT
you will find all the latest designs in corrective
appliances.
Brewer & Company, Inc., 12 East Worcester
Street, Worcester, Massachusetts.
Brewer and Company produces a very fine line
of enteric coated specialties, as follows: Theso-
date* enteric coated tablets and gelatin capsules
for the treatment of Coronary AiTery Disease,
Luasmin enteric coated tablets and gelatin cap-
sules for the relief of Bronchial Asthma, and en-
teric coated Codeine Phosphate Tablets, 44 grain,
for the relief of useless coughs.
* Featured at our exhibit.
The Doho Chemical Corporation, 58 Varick Street,
New York City.
Animated Pathological Ear Exhihit.
The Auralgan Exhibit consists of a model of the
human auricle, four feet high, together with a
series of twenty-four three dimensional ear drums,
modelled under the supervision of outstanding
otologists. Each of these drums depicts a different
pathologic condition based upon actual case obser-
vation and prepared, in so far as possible, with
strict scientific accuracy so as to be highly instruc-
tive and interesting to all physicians.
Geo. C. Frye Co., 116 Free Street, Portland, Maine.
The George C. Frye Company is again happy to
extend a cordial invitation to the members of the
Maine Medical Association to visit their booth at
the forthcoming annual meeting.
There will be on display new items of interest
to the medical profession and our representatives
will be pleased to have the opportunity of discuss-
ing present-day problems with their many friends.
Our booth will be in charge of Mr. Sidney F.
Cheney and Mr. Claude W. Lamson, who regularly
contacts the physicians of this State.
General Electric X-Ray Corporation, Branch Office,
620 Beacon Street, Boston, Massachusetts.
The General Electric X-Ray Corporation realizes
the importance of the continuity of medical society
meetings, as well as the dissemination of medical
information, and will continue to support the
Maine Medical Association meeting thereby con-
tributing to its record of continuous performance.
The physicians are invited to stop in and discuss
their problems of new and used X-ray and electro-
medical apparatus and their technical problems.
E. F. Mahady Company, 851-857 Boylston Street,
Boston, Massachusetts.
At the E. F. Mahady Company exhibit, Mr. Per-
kins will demonstrate a complete line of Burdick
physical therapy equipment. Mr. Mills will be on
hand to explain Cutter’s intravenous solutions and
plasma and Cutter’s equipment for hospital prepa-
ration of plasma.
Maine Surgical Supply Company, 10 Longfellow
Square, Portland, Maine.
May we extend to the members of the Maine
Medical Association a cordial invitation to visit
our exhibit at the State convention. We welcome
these annual meetings for it gives us the oppor-
tunity to greet our present customers and make
new friends. This year we will endeavor to display
new items of interest to all members. John Lacy
and Ernest Niles will be present to welcome one
and all.
Mead Johnson & Company, Evansville, Indiana.
“Servamus Fidem” means We Are Keeping the
Faith. Almost every physician thinks of Mead
Johnson & Company as the maker of Dextri-Mal-
tose, Pablum, Oleum Percomorphum, and other
infant diet materials. But not all physicians are
aware of the many helpful services this progres-
sive company offers physicians. A visit to our
booth will be time well spent.
Philip Morris & Co., Ltd., 119 Fifth Avenue, New
York City.
Philip Morris & Company will demonstrate the
method by which it was found that Philip
Morris Cigarettes, in which diethylene glycol is
used as the hygroscopic agent, are less irritating
than other cigarettes. Their representative will
be happy to discuss researches on this subject, and
problems on the physiological effects of smoking.
The P. J. Noyes Company, Lancaster, New Hamp-
shire.
We are grateful for the opportunity of contrib-
uting in a modest way towards the success of the
meeting of the Maine Medical Association. Joe E.
Brown, Representative.
Nineteen Hundred and Forty-two — June
Petrogalar Laboratories, 8134 McCormick Boule-
vard, Chicago.
Physicians are cordially invited to visit the
Petrogalar exhibit where a new and enlightening
story on Petrogalar, an aqueous suspension of min-
eral oil, will be related. Beautifully colored ana-
tomical drawings and new literature may be had
upon request from our representative, Mr. G. E.
Schneider, who will be in conslant attendance.
Phospho-Soda (Fleet). The C. B. Fleet Co., Inc.,
Lynchburg, Virginia.
An ethical house, long known for a single
product.
What may you, as a Maine physician, expect
from this stable, non-toxic concentrate of the two
U. S. P. sodium phosphates?
1. Accurate dosage, regulated to the patient and
to his condition.
2. The maximum therapeutic effectiveness of
sodium phosphate.
3. Quick, gripeless evacuation, for emergencies.
4. Mild, controllable elimination, for chronic
biliary disturbance or constipation.
5. Unusual freedom from after-irritation, with
normalizing buffer action.
6. Safe action with administration of the sul-
fonamides.
Are you getting the full value of Phospho-Soda
(Fleet) in your daily problems of elimination?
Secure samples at the convention, with souvenir.
Schering Corporation, Bloomfield, New Jersey.
Oreton, the most potent androgenic hormone
known to medicine; Oreton-M Tablets for orally
effective male hormone therapy; Pranone, the
orally effective corpus luteum preparation — in fact,
all the highly advanced Schering hormones are on
display at the Schering exhibit, which is practi-
cally a survey of recent endocrine progress. In
addition, there are some other particularly inter-
esting products such as Sulamyd (Sulfacetimide)
139
for the treatment of urinary tract infections, and
Sulfadiazine-Schering, most efficient sulfonamide
for pneumonia. Members of the Medical Research
Division will be present and welcome discussion
of problems.
Attending Representatives: Dr. William Stoner,
and Mr. R. W. St. Clair.
Surgeons’ & Physicians’ Supply Co., 761 Boylston
Street, Boston, Massachusetts.
The Surgeons’ & Physicians’ Supply Company’s
booth will be in charge of our Maine representa-
tive, Mr. Charles H. Joy. We will have on hand
as many new and interesting items as we can, and
if possible, equipment that we don’t very often
have the opportunity to exhibit.
Tailby-Nason Company, Boston, Massachusetts.
Tailby-Nason Company, Pharmaceutical Manu-
facturers of Boston, Massachusetts, will have a dis-
play of Vitaguent (Cod Liver Oil Ointment) and
medicinal tablets, Minto-Payes for Indigestion, Po-
tensors for Blood Pressure.
John Wyeth & Brother, Inc., 1600 Arch Street,
Philadelphia.
You are cordially invited to visit the booth
where John Wyeth & Brother will exhibit the
Hemo-Guide, an aid in hematologic diagnosis. In
addition, the following Wyeth specialties will be
displayed :
Amphojel — Wyeth’s Alumina Gel for the control
of hyperacidity and peptic ulcer.
B-Plex — The complete vitamin B complex.
Bepron — Wyeth’s beef liver with iron for the
nutritional anemias.
Kaoviagma— For the control of diarrhea and
colitis.
A-B-M-C Ointment — For the relief of arthritic
pain.
Silver Picrate Products — For the treatment of
trichomonas and anterior urethritis.
THE ZEMMER COMPANY, Oakland Station , PITTSBURGH , PA.
PRESCRIBE OR DISPENSE ZEMMER
Pharmaceuticals . . . Tablets, Lozenges, Ampoules, Capsules,
Ointments, etc. Guaranteed reliable potency. Our products
are laboratory controlled. Write for general price list.
Chemists to the Medical Profession.
MA6-42
WHY DON’T YOU
GET YOUR PAY?
Over 500 physicians and 20 hospitals have increased
their incomes by placing their accounts with us for V..^ l- 1 i
adjustment, in a humane, honest and efficient ^ ...
manner. So can you — let us tell you how. ,/ details con-
y cermng: your service.
Reference: Maine Medical Association Secretary /Name
MEDICAL AUDITING COUNSEL ✓''Street
297 WESTERN PROMENADE PORTLAND. MAINE ^^ity
140
The Journal of the Maine Medical Association
Treasurer’ s Report — Continued from page 130
Statement of Revenue and Expense,
One Year Ended May 31, 1942
REVENUE
Dues $ 5,548.00
Income from Securities 315.00
Interest Received 204.87
Exhibit Space — 1941 Conven-
tion 883.00
C. M. A. B. Advertising 2,592.33
Local Advertising 1,074.72
Subscriptions and Sales of
Journals 15.00
Total Revenue $10,632.92
EXPENSES
Salaries : —
Dr. Jackson, Editor $1,000.00
Dr. Carter, Secretary and
Treasurer 1,200.00
Mrs. Kennard, Assistant Secre-
tary 1,500.00
Travel Expenses: —
President 300.00
Secretaries 159.58
Councilors 85.26
Office Expenses: —
Office Assistants 119.50
Supplies and Stationery 373.98
Postage and Mailing Expense 172.41
Rent 300.00
Telephone 133.55
Lights 11.00
Auditing 53.50
Miscellaneous 81.70
Committee, Graduate Education 59.62
Clinical Session 37.10
Delegates, N. E. Medical Socie-
ties 14.00
A. M. A. Meeting 91.75
Medical Advisory Committee .... 515.67
Annual Meeting 545.72
Printing 3,439.29
Plates 78.19
Total Expenses 10,271.82
Revenue in Excess of
Expense — One
Year $361.10
Statement of Cash Receipts and Disbursements,
One Year Ended May 31, 1942
Cash in Banks, June 1, 1941 .... $14,542.09
RECEIPTS
Received from Dues $5,476.00
Income from Investments 519.87
Exhibit Space Rentals 827.00
Liquidating Dividend — Fidel-
ity Trust Co 154.43
Subscriptions and Sale of
Journals 15.00
Advertising 3,738.57
Refund from Eye and Ear Com-
mittee 60.45
10,791.32
$25,333.41
DISBURSEMENTS
Salaries $3,700.00
Traveling Expenses 544.84
Office Expenses 1,245.64
Committees, Clinical Session
and A. M. A. Meeting 202.47
Annual Meeting — 1941 and 1942 541.92
Medical and Advisory Commit-
tee 515.67
Printing and Plates 3,517.48
New Equipment 143.66
10,411.68
Cash in Banks — May 31,
1942 $14,921.73
Canal National Bank — Check-
ing Account $3,246.59
Canal National Bank — Savings
Account 2,035.82
Maine Savings Bank 4,615.66
Portland Savings Bank 4,577.71
First National Granite Bank .... 445.95
$14,921.73
j V VICTORY V
^ Victory will be ours if we cooperate, we are endeavoring, under existing condi-
tions, to do our share by giving prompt and efficient service to our Maine
^ Hospitals and Physicians.
j MAINE SURGICAL SUPPLY CO.
U 10 Longfellow Square Portland, Maine
5
!!
5
5
5
5
5
Nineteen Hundred and Forty-two — June
141
OFFICIAL ROSTER
OFFICERS AND MEMBERS
OF THE
MAINE MEDICAL ASSOCIATION
19 4 2
MEMBERS IN MILITARY SERVICE
ANDROSCOGGIN
BEEAKER, VINCENT, 54 Pine St., Lewiston
CEAPPERTON, GILBERT,
Lovell Gen. Hosp., Ft. Devens, Mass.
FROST, ROBERT A., Naval Hosp., Norfolk, Va.
MANDELSTAM, A. W.,
Naval Hosp., Portsmouth, N. H.
WEBBER, AVEDGWOOD P., 31 Western Ave., Augusta
AROOSTOOK
BLOSSOM, FRANK O., Miami, Florida
EBBETT, GEORGE H., Camp Polk, Louisiana
CUMBERLAND
CASEY, AA’ILLIAM L., Camp Blanding, Florida
CLANCEY, DANIEL J., 33 Kay St., Newport, R. I.
DANIELS, DONALD H., 5 Bramhall St., Portland
DRAKE, EUGENE H.,
Wallis Sands Rd.. Portsmouth, N. H.
DUNHAM, CARL E., 201 State St., Portland
FAGONE, FRANCIS A.,
Station Hosp., Fort Devens, Mass.
FINKS, HENRY B., Station Hosp., Dow Field, Bangor
FOGG, C. EUGENE, Station Hosp., Fort McKinley
GETCHELL, RALPH A., Station Hosp., Fort Williams
HEIFETZ, RALPH, Station Hosp., Fort AAhlliams
HYNES, EDAA’AKD A., Star Route, Myrtle Grove, Fla.
LOMBARD, REGINALD T., 793 Main St., So. Portland
LOA E, ROBERT B., Gorham
PHILLIPS, ROBERT T., 131 State St., Portland
SMITH, KENNETH E., 45 Deering St., Portland
KENNEBEC
COOK, AARON, 44 Main St., Waterville
FISHER, SAMSON, Maxwell Field, Montgomery, Ala.
IRGENS, EDAVIN R.. 20 Haven Rd., South Portland
LAMBERT, GREENLEAF H., Winthrop
LATHBURYh A'lNCENT T., 77 Winthrop St., Augusta
AIcAVETHY, AVILSON H.,
Camp Hulen, Palacios, Texas
METZG.\R, JOHN, 172 State St., Augusta
TOAVNE, CHARLES AV., 135 Main St., AA^aterville
TOAVNE, JOHN G., 31 Western Ave., Augusta
TRASK, BURTON AV.,
Station Hosp., Camp Edwards, Mass.
KNOX
APOLLONIO, HOAVARD L., 6 Wood St., Camden
KAZUTOAA', JOHN, Memorial Hosp., New York City
LINCOLN-SAGADAHOC
STOTT, ARDENNE A., 119 Front St., Bath
PENOBSCOT
CLOUGH, HERBERT T., JR.,
463.4. Congress St., Portland
CUTLER, LAAA’RENCE M., Camp Blanding, Florida
GREGORY, I. FRANCIS, 255 Hammond St., Bangor
HINM.VN, HAAILAH E., Orono
PRESSEY, HAROLD E., Camp Blanding, Florida
SHAPERO, BENJAMIN L., 73 Broadway, Bangor
AVITTE, MAX E., JR., Fort Devens, Mass.
PISCATAQUIS
THOMAS, WHLLIAM B. S., Dover-Foxcroft
WASHINGTON
KNAPP, ALLAN H., Machias
METCALF, JOHN, Station Hosp., Ft. Devens, Mass.
YORK
GOULD, GEORGE I., Ft. Devens, Mass.
KENDALL, CL.VRENCE F.,
136-05 Sanford St., Flushing, N. Y.
MYER, JOHN C., North Berwick
TOAA’ER, ELMER M., Ogunquit
142
The Journal of the Maine Medical Association
ANDROSCOGGIN COUNTY
OFFICERS
President, Camp C. Thomas, Eewiston
Vice-President, I). F. D. Russell, Reeds
Secretary-Treasurer, Charles W. Steele, Eewiston
WAKEFIERD, FREDERICK S.
AVEBBER, WAEEACE E.,
WIEEIAMS, JAMES A.,
AAISEMAN, ROBERT J.,
324 Main St., Lewiston
297 Main St., Lewiston
Mechanic Falls
140 Lincoln St., Lewiston
MEMBERS
ANDREAVS, SULLIVAN L.
BELIVEAU, BERTRAND /
BELIVEAU, ROMEO A.,
BERNARD, ROMEO A.,
BOLSTER, AA ILLIAM AV.,
BOUSQUET, JEAN,
BRIEN, MAURICE,
BROOKS, GLIDDEN L.,
BUKER, EDSON B.,
BUSCH, JOHN J.,
138 Pine St., Lewiston
, 100 Pine St., Lewiston
89 Pine St., Lewiston
144 Pine St., Lewiston
210 College St., Lewiston
91 Bartlett St., Lewiston
86 Pine St., Lewiston
300 Main St., Lewiston
80 Goff St., Auburn
Mechanic Palls
CALL, ERNEST V.,
CARON, FREDERICK J.,
CARTLAND, JOHN E.,
CHAFFERS, AVILLIAM H.
CHENERY, FREDERICK
CHEVALIER, PAUL R.,
CORRAO, FRANK P.,
COX, AVILLIAM V.,
DESAULNIERS, GEORGE
DIONNE, MAURICE J.,
FAHEY, AVILLIAM T.,
118 Pine St., Lewiston
174 Bates St., Lewiston
117 Goff St., Auburn
190 Bates St., Lewiston
I., JR., Monmouth
240 Lisbon St., Lewiston
279 Lisbon St., Lewiston
133 Court St., Auburn
E. D.,
106 Chestnut St., Lewiston
Bi'unswick
17 Frye St., Lewiston
GARCELON, HAROLD AV.,
GAUVREAU, HORACE L.,
GERRISH, LESTER P.,
GIGUERE, EUSTACHE N.,
GOLDMAN, MORRIS E.,
GOODAVIN, RALPH A.,
GOTTLIEB, JULIUS,
GRANT, ALTON L., JR.,
GREENE, MERRILL S. F.,
GROSS, LEROY C.,
2 Goff St., Auburn
82 Pine St., Lewiston
Lisbon Falls
109 Cedar St., Lewiston
487 Main St., Lewiston
56 Dennison St., Auburn
49 Central Ave., Auburn
133 Court St., Auburn
386 Main St., Lewiston
19 Goff St., Auburn
HANSCOM, OSCAR E.,
HARKINS, MICHAEL J.,
HAYDEN, LOUIS B.,
HIEBERT, JOELLE C.,
HIGGINS, EVERETT C.,
HIRSHLER, MAX,
JAMES, CHAKMAKIS,
MARCOTTE, JOHN B.,
MARSTON, EDAVIN J.,
MILLER, HUDSON R.,
MURPHY, D. JEROME,
Greene
28 Union St., Lewiston
Livermore Palls
240 College St., Lewiston
149 College St., Lewiston
85 Pine St., Lewiston
133 College St., Lewiston
280 Lisbon St., Lewiston
76 Goff St., Auburn
11 Turner St., Auburn
126 College St., Lewiston
PEASLEE, CLARENCE C.
PELLETIER, ANTHONY ]
PIERCE, EDAVIN F.,
PLUMMER, ALBERT AV.,
POULIN, J. EMILE,
PRATT, HAROLD S.,
RAND, CARLETON H.,
RAND, GEORGE H.,
RENAVICK, AVARD J.,
ROAVE, GUNTHNER H„
ROY, LEOPOLD O.,
RUSSELL, BLINN AV.,
RUSSELL, DANIEL F, D.,
SANSOUCY, JEROME A.,
SCHNEIDER, GEORGE A.,
STEELE, CHARLES AV.,
SAVEATT, LINAVOOD A.,
, 42 Goff St., Auburn
). J.,
10 Hammond St., Lewiston
24 Frye St., Lewiston
Lisbon Palls
198 Lisbon St., Lewiston
Livermore Palls
166 College St., Lewiston
Livermore Palls
102 Goff St., Auburn
Livermore Palls
54 Pine St., Lewiston
98 Pine St., Lewiston
Leeds
76 Pine St., Lewiston
198 Lisbon St., Lewiston
472 Main St., Lewiston
268 Main St., Auburn
THOMAS, CAMP C., 22 Wakefield St., Lewiston
TIBBETTS, OTIS B., 33 Court St., Auburn
TOUSIGNANT, CAMILLE, 111 Pine St., Lewiston
TWADDLE, GARD AV., 57 Goff St., Auburn
VILES, WALLACE E.,
Turner
AROOSTOOK COUNTY
OFFICERS
President, Harold E. Small, Fort Fairfield
Afice-President, Thomas G. Harvey Mars Hill
Seeretary-Treasurer, Gerald H. Donahue, Presque Isle
M E M
ALBERT, ARMAND,
ALBERT, JOSEPH L.,
BERRIE, LLOYD H.,
BOONE, STORER AV.,
BREAVER, AA ILFRED R.,
BURR, CHARLES G.,
CARTER, LOREN F.,
CURTIS, ALTON K.,
B E R S
Van Buren
St. Francis
Caribou
Presque Isle
7 Hanover Square, N. Y. C.
Houlton
Presque Isle
Danforth
DAMON, ALBERT H.,
DOBLE, EUGENE H.,
DONAHUE, GERALD H.,
DONOVAN, JOSEPH A.,
Limestone
Presque Isle
Presque Isle
Houlton
EBBETT, PENRY L. B.,
Houlton
FAUCHER, FRANCOIS J.,
GAGNON, BERNARD H.,
GIBSON, AVILLIAM B.,
GORMLEY, EUGENE G.,
GRAVES, RICHARD A.,
GREGORY, FREDERICK L.,
GRIFFITHS, EUGENE B.,
GROW, WILLIAM B.,
HAMMOND, H. HERBERT,
HARVEY, THOMAS G.,
HUGGARD, LESLIE H.,
Grand Isle
Houlton
Houlton
Houlton
Presque Isle
Caribou
Presque Isle
Presque Isle
Van Buren
Mars Hill
Limestone ,
JACKSON, FRANK II.,
KELLOCH, H. F.,
KIMBALL, HERRICK C.,
KIRK, AVILLIAM V.,
LABBE, ONIL B.,
LARRABEE, FAY F.,
MITCHELL, FREDERICK AV.,
NORELL, OSCAR,
Houlton
Port Fairfield
Port Fairfield
Eagle Lake
Van Buren
Washburn
Houlton
Caribou
SAVAGE, RICHARD L.,
SMALL, HAROLD E.,
SOMERVILLE, ROBERT B.,
SOMERVILLE, AV ALLACE B.,
SAVETT, CLYDE I.,
Port Kent
Port Fairfield
Presque Isle
Mars Hill
Island Palls
TOUSSAINT, LEONIDE G.,
Fort Kent
AVARD, PARKER M.,
Houlton
HONORARY
DOBSON, LINDLEY,
SINCOCK, AVILEY E.,
UPTON, GEORGE AV.,
MEMBERS
Presque Isle
Caribou
Sherman
CUMBERLAND COUNTY
OFFICERS
President, Roland B. Moore, Portland
ATce-President, N. B. T. Barker, A'armoiith
Seeretary-Treasurer, Eugene E. O’Donnell, Portland
MEMBERS
ALLEN, JOHN H.,
ASALI, LOUIS A.,
BABALIAN, LEON,
BARKER, NATHANIEL
Pond Cove, Cape Elizabeth
12 Chatham St., Portland
32 Deering St., Portland
B. T., Yarmouth
Nineteen Hundred and Forty-two — June
143
BEACH, S. JUDD, 704 Congress St., Portland
BECK, HENRY W., Gray
BICK3IOEE, HAROED V., 723 Congress St., Portland
BISHOFFBERGER, JOHN M., Naples
BISHOP, EEOYD W., 211 Vaughan St., Portland
BEAISDEEE, EETON R., 12 Peering St., Portland
BEAKE, JAMES P., Harrison
BRAMHAEE, THEODORE C.,
704 Congress St., Portland
BRANSON, SIDNEY R., 37 Main St., South Windham
BROWS, EUTHER A., 13 Peering St., Portland
BROAVN, STEPHEN S., 22 Arsenal St., Portland
BURRAGE, TH03IAS J., 142 High St., Portland
CARMICHAEE, FRANK E., 72 Peering St., Portland
CHRISTENSEN, HARRY E.,
29 Peering St., Portland
CEARKE, CHESTER E., 10 Congress Square, Portland
CEOUGH, DEXTER J., 10 Pow St., Portland
CRAGIN, CHAREES E., 831 Congress St., Portland
CUM3IINGS, GEORGE O., 47 Peering St., Portland
CURTIS, HARRY E., 142 High St., Portland
DAVIS, HARRY E., 757 Congress St., Portland
DAVIS, PAUE V., Bridgton
DOOEEEh FRANCIS M., 53 Peering St., Portland
DORE, KENNETH E., Frjeburg
DORSEY, FRANK D., 52 Peering St., Portland
DOUPHINETT, OTIS J., 188 State St., Portland
DRUMMOND, JOSEPH B., 62 State St., Portland
DYER, HENRY E., Berlin, N. H.
EMERi:, HARRY S., 721 Stevens Ave., Portland
EVERETT, HAROED J., 308 Panforth St., Portland
FERGUSON, FRANKEIN A., 9 Peering St., Portland
FICKETT, JEROME P., Naples
FIEES, ERNEST AV., 201 State St., Portland
FISHER, STANAA'OOD E., 388 Spring St., Portland
FOSTER, AEBERT D.,
Bay Shore Prive, Falmouth Foreside
FOSTER, BENJA3IIN B., 300 Panforth St., Portland
FOSTER, THOMAS A., 131 State St., Portland
GEER, GEORGE I., 756 Congress St., Portland
GEHRING, EDAA'IN AA'., 131 State St., Portland
GORDON, CHAREES H., 46 Peering St., Portland
GOUED, ARTHUR E., Freeport
GRECO, EDAVARD A., 12 Pine St., Portland
HAEE, EARE S.,
HAM, JOSEPH G.,
HAMEE, JOHN R.,
HANEY, ORMEE E.,
HANEON, FRANCIS AV.,
696 Congress St., Portland
32 Peering St., Portland
50 Peering St., Portland
74 Peering St., Portland
46 Peering St., Portland
HANSON, HENRY W., JR., Cumberland Center
HASKEEE, AEFRED AA'., 142 High St., Portland
HATCH, EUCINDA B., 27 Peering St., Portland
HAAA'KES, RICHARD S., 21 Peering St., Portland
HAY, AA’AETER F. AV., 131 State St., Portland
HEBB, HENRY S., 63 Main St., Bridgton
HIEES, EOUIS E., 816 Main St., AVestbrook
HOET, C. EAAA'RENCE, 29 Peering St., Portland
HOET, E. EUGENE, JR., 723 Congress St., Portland
HOET, AVIEEIAM, 14 Peering St., Portland
HOAA'ARD, HARA EY, Freeport
HUNT, CHAREES H., 60 Winter St., Portland
HUNTRESS, RODERICK E.,
10 Congress Square, Portland
JAMIESON, JAMES G. S., 82 High St., Portland
JOHNSON, AEBERT C., 131 State St., Portland
JOHNSON, GORDON N., 201 State St., Portland
JOHNSON, HENRY P., 32 Peering St., Portland
JOHNSON, OSCAR R., 18 Peering St., Portland
KUPEEIAN, NESSIB S., Pownal
EAMB, HENRY AV., 131 State St., Portland
EAPPIN, JOHN J., 171 State St., Portland
EAUGHEIN, K. AEEXANDER, 131 State St., Portland
EEIGHTON, ADAM P., 192 State St., Portland
EEIGHTON, AA'IEBUR F., 192 State St., Portland
EITTEE, AEBION H., 692 Congress St., Portland
EOGAN, G. E. C., 131 State St., Portland
EOTHROP, EATON S., 690 Congress St., Portland
MACDONAED, H. EUGENE, 21 Peering St., Portland
MARSTON, PAUE C., Kezar Falls
MARTIN, RAEF, 58 Peering St., Portland
MARTIN, THOMAS A., 131 State St., Portland
McADAMS, WIEEIAM R., 704 Congress St., Portland
McCRUM, PHIEIP H., 188 State St., Portland
McDERAIOTT, EEO J., 1.51 A^aughan St., Portland
McEEAN, E. AEEAN, 29 Peering St., Portland
McMANAMY, EUGENE P., 29 Peering St., Portland
MEENICK, JACOB, 333 Congress St., Portland
MIEEER, THOR, 752 Main St., Westbrook
MIEEIKEN, HERBERT E., Surry
MIEEIKEN, JOHN S., 21 A^eranda St., Portland
MITCHEEE, AEFRED, JR., Prout’s Xeck
MONKHOUSE, AA'IEEIAAI 31., 335 Spring St., Portland
3IOORE, ROEAND B., 201 State St., Portland
3IORRISON, AEA'IN A., 5 Peering St., Portland
3IOUETON, AEBERT AAh, 180 State St., Portland
MUNRO, BURTON S., Berlin, N. H.
NEEDEE3IAN, AVIEEIA3I R.,
312 Congress St., Portland
NICHOES, ESTES, 1 Peering St., Portland
O’DONNEEE, EUGENE E., 32 Peering St., Portland
ORA3I, J. C AEA'IN, 1 Mitchell Rd., So. Portland
OTTU3I, AEA'IN E., 31 Peering St., Portland
PARKER, JA3IES 31., 31 Peering St., Portland
PATTERSON, JA3IES,
614 Highland Ave., So. Portland
PEASEEE, C. CAPEN, JR., 339 Woodford St., Portland
PEPPER, JOHN E., 960 Sawj'er St., So. Portland
PETERS, CEINTON N., 10 Congress Square, Portland
PINGREE, HAROED A., 131 State St., Portland
POORE, GEORGE C., 192 State St., Portland
PORTER, JOSEPH E., 22 Arsenal St., Portland
RICHARDSON, CEYDE E., Brunswick
RIDEON, 3IAGNUS G„ Kezar Falls
ROBINSON, CARE 31., 31 Peering St., Portland
ROBINSON, EDAVARD F., Falmouth
ROAA'E, DANIEE 31., 757 Congress St., Portland
SAPIRO, HOAA'ARD 31., West Scarboro
SAAVYER, SA3IUEE G., Cornish
SCHAVARTZ, CAROE, 209 State St., Portland
SCOETEN, ADRIAN, 201 State St., Portland
SHANAHAN, AVIEEIA3I H., 306 Congress St., Portland
SI31ECEK, A'ICTOR H., 179 Main St., Brunswick
S3IITH, FRANK A., 343 Main St., AVestbrook
S3IITH, OAA'EN, 692 Congress St., Portland
SPENCER, JACK, 31 Peering St., Portland
STETSON, EEBRIDGE, G. A., Brxinswick
STEA'ENS, THEODORE 31., 32 Peering St., Portland
STUART, AEBERT F., U. S. Marine Hosp., Portland
SAA'IFT, HENRY 31., 131 State St., Portland
TABACHNICK, HENRY 31.,
312 Congress St., Portland
TETREAU, TH03IAS, 389 Congress St., Portland
THAXTER, EANGDON T., 31 Peering St., Portland
TH03IPS0N, 3IIETON S., 31 Peering St., Portland
TH031PSON, PHIEIP P., 704 Congress St., Portland
TIBBETTS, GEORGE A.,
519 Cumberland Ave., Portland
TOBIE, AVAETER E., 3 Peering St., Portland
TOUGAS, RAY3IOND, Brunswick
UEPTS, REYNOED G. E., 271 Western Prom., Portland
UPHA3I, ROSCOE C., 15 Crescent St., Biddeford
AVAEKER, 3IARIBEE H., Cape Cottage
AVARD, JOHN A'., 45 Peering St., Portland
AA'ARREN, 3IORTI3IER, 22 Arsenal St., Portland
AA'EBB, HAROED R., Brunswick
AA'EBBER, ISAAC 31., 29 Peering St., Portland
AVEBBER, 31. CARROEE, 735 Stevens Ave., Portland
AA'EBSTER, FRED P., 10 Congress Square, Portland
AA'EEKS, DeFOREST, 158 Pleasant Ave., Portland
AA'EECH, FRANCIS J., 44 Peering St., Portland
AA EEEINGTON, J. FOSTER,
655 Congress St., Portland
AA'ESCOTT, CEE3IENT P., 1600 Forest Ave., Portland
AA'HEET, FREDERICK E., 773 Main St., Westbrook
AA'HITNEY, HAREAN R., 655 Congress St., Portland
AVHITTIER, AEICE A. S., 143 Neal St., Portland
AVIGHT, DONAED G., 438 Cottage Rd., So. Portland
144 The Journal of the Maine Medical Association
WILMAMS, RALPH E., Freeport
WILSON, CLEMENT S., Brunswick
WOODMAN, ARTHUR B., Falmouth Foreside
WOODMAN, GEORGE M., 826 Main St., Westbrook
ZOLOV, BENJAMIN, 296 Congress St., Portland
KENNEBEC COUNTY
OFFICERS
President, L. Armand Guite,
Vice-President, Adolphe J. Gingrras,
Secretary-Treasurer, Frederick R. Carter,
W atervUle
Augusta
Augusta
HONORARY MEMBERS
ABBOTT, EDWARD S., Bridgton
BATES, GEORGE F., Eastland Hotel, Portland
BRADFORD, AVILLIAM H., 11 Carleton St., Portland
BROCK, HENRY H., Alfred
MARSHALL, BERTRAND F., 813 Main St., Westbrook
PUDOR, GUSTAV A., 142 High St., Portland
FRANKLIN COUNTY
OFFICERS
President, Janies W. Reed, Farmington
Vice-President, Harry Brinkman, Farmington
Secretary-Treasurer, George L. Pratt, Farmington
MEMBERS
ARMS, BURDETT L., 20 High St., Farmington
BELL, CHARLES W., 36 Main St., Farmington
BRINKMAN, HARRY, 47 Perhman St., Farmington
COLLEY, MAYNARD B., Main St., Wilton
CROTEAU, J. THOMAS, Church St., Chisholm
CURRIER, EVERETT B., Main St., Phillips
DUNLAP, CLARENCE J., Kingfleld
FLOYD, ALBION E., New Sharon
LaTOURETTE, KENNETH A.,
Franklin County Mem. Hosp., Farmington
MOULTON, JOHN H., Rangeley
PRATT, GEORGE L., 7 Main St., Farmington
REED, JAMES W., 14 Main St., Farmington
SCHMIDT, LORRIMER M.,
SPRINGER, FRANK L.,
THOMPSON, CECIL F.,
WEYMOUTH, CURRIER C.,
WHITE, VERDEIL O., ;
Main St., Strong
102 Main St., Farmington
Dodge Rd., Phillips
83 Main St., Farmington
4 Howard St., Springvale
HANCOCK COUNTY
OFFICERS
President, Ralph W. Wakefield, Bar Harbor
Vice-President, Charles C. Knowlton, Ellsworth
Secretary-Treasurer, Marcus A. Torrey, Ellsworth
MEMBERS
BABCOCK, HAROLD S.,
Castine
BLISS, RAYMOND V. N.,
Bluehill
CLARKE, RAYMOND AV.,
Ellsworth
COFFIN, ERNEST L.,
Northeast Harbor
COFFIN, RAYMOND B.,
Southwest Harbor
COFFIN, SILAS A.,
Bar Harbor
CROWE, JAMES H.,
Ellsworth
GRAY, PHILIP L.,
Harborside
HOLT, HIRAM ALLEN,
Winter Harbor
KNOWLTON, CHARLES C.,
Ellsworth
LARRABEE, CHARLES F.,
Bar Harbor
MILLSTEIN, HYMAN,
Southwest Harbor
MORRISON, CHARLES C., JR.,
Bar Harbor
NOYES, B. LAKE,
Stonington
PARCHER, ARTHUR H.,
Ellsworth
PARCHER, GEORGE,
Ellsworth
SUMNER, CHARLES M.,
Sullivan
THEGEN, EDWARD,
Penobscot
TORREY, MARCUS A.,
Ellsworth
WAKEFIELD, RALPH W.,
Bar Harbor
WEYMOUTH, RAYMOND E.,
Bar Harbor
HONORARY M
EMBER
PHILLIPS, JOSEPH D.,
Southwest Harbor
MEMBERS
ABBOTT, HENRY W., 116 Main St., Waterville
ALEXANDER, GEORGE W.,
128 Dresden Ave.. Gardiner
ALLEN, ADELBERT B.,
ALMOND, HENRY,
BAUMAN, CLAIR S.,
BISSON, NAPOLEON,
BOURASSA, HARVEY J.,
BREARD, JOSEPH A.,
BULL, FRANK B.,
BUNKER, LUTHER G.,
59 Front St., Richmond
Gardiner
177 Main St., Waterville
28 Common St., Waterville
50 Main St., Waterville
15 Summer St., Waterville
Gardiner
50 Main St., Waterville
CAMPBELL, GEORGE R., 175 Water St., Augusta
CARTER, FREDERICK R.,
Augusta State Hospital, Augusta
CATES, SAMUEL C., East Vassalboro
CLASON, SILAS O., Gardiner
CONLOGUE, EVERETT F.,
Oakville Mem. San., Oakville, Tennessee
COOMBS, GEORGE A., 283 Water St., Augusta
CROMWELL, CHARLES D.,
Central Maine Sanatorium, Fairfield
CYR, GERALD A., 179 Main St., Waterville
FAY, THOMAS F., 341 Water St., Augusta
FREEMAN, FRED H., Pittsfield
GIDDINGS, PAUL D.,
GINGRAS, ADOLPHE J.,
GINGRAS, NAPOLEON J.,
GOODRICH, BLYNN O.,
GOUSSE, WILLIAM L.,
GUITE, L. ARMAND,
284 Water St., Augusta
99 Water St., Augusta
105 Water St., Augusta
165 Main St., Waterville
Fairfield
27 Main St., Waterville
HARDMAN, WILLIAM W.,
Veterans’ Administration, Togus
179 Main St., Waterville
HARDY THEODORE E.,
HARLOW, EDWIN W.,
HERRING, LEON D.,
HILL, FREDERICK T.,
HILL, HOWARD F.,
HIRSCHBERGER, CELIA,
HURD, ALLAN C.,
JACKSON, ELMER H.,
177 Main St., Waterville
Winthrop
177 Main St., Waterville
177 Main St., Waterville
44 Main St., Waterville
Gardiner
304 Water St., Augusta
KAGAN, SAMUEL H., 283 Water St., Augusta
KENNEY, CLARENCE J.,
Veterans’ Administration, White River Jet., Vt.
KOBES, HERBERT R., State House, Augusta
LIBBY, ABA B., 295 Water St., Gardiner
LUBELL, MOSES F., 50 Roosevelt Ave., Waterville
MANN, LEWIS L., 177 Water St., Augusta
MARQUARDT, MATTHIAS,
Augusta State Hospital, Augusta
Me COY, THOMAS C., 90 Main St., W'aterville
McKAY, ROLAND L., 284 Water St., Augusta
McLaughlin, clarence r..
McLaughlin, ivan e.,
McQuillan, a. h.,
MERRILL, PERCY S.,
MICHAUD, JOSEPH H. C.,
MOORE, ARNOLD W.,
MORRELL, ARCH H.,
MURPHY, NORMAN B.,
NEWCOMB, CHARLES H.,
O’CONNOR, WILLIAM J.,
ODIOBNE, JOSEPH E.,
PARIZO, HARRY L.,
PIPER, JOHN O.,
POMERLEAU, OVID F.,
POMERLEAU, RODOLPHE
POULIN, JAMES E.,
345 Water St., Gardiner
345 Water St., Gardiner
177 Main St., Waterville
82 Elm St., Waterville
44 Main St., Waterville
Mt. Vernon
State House, Augusta
284 Water St., Augusta
Clinton
341 Water St., Augusta
Coopers Mills
2 Silver St., Waterville
177 Main St., Waterville
177 Main St., Waterville
tJ F
27 Main St., Waterville
177 Main St., Waterville
Nineteen Hundred and Forty-two — June
145
PRATT, T. DENNIE,
PRIEST, MAURICE A.,
PROVOST, HEEEN C.,
PROVOST, PIERRE E.,
47 Silver St., Waterville
283 Water St., Augusta
48 Green St., Augusta
284 Water St., Augusta
REYNOEDS, RAEPH E., 101 Main St., Waterville
RISEEY, EDWARD H., 27 College Ave., Waterville
ROSENBERG, NATHAN,
Veterans’ Administration, Togus
SHEETON, M. TIECHE, 315 Water St., Augusta
SMAEE, MORTON M., 28 Common St., Waterville
STUBBS, RICHARD H., 133 State St., Augusta
TURNER, OEIVER W., 37 Stone St., Augusta
TURNER, RODNEY D., 30 Grove St., Augusta
TYSON, FORREST C., Augusta State Hospital, Augusta
VENTIMIGEIA, WIEEIAM A.,
Veterans’ Administration, Togus
WHEEEER, FRED E., 65 Temple St., Waterville
WHEEEER, JOSEPH E.,
Veterans’ Administration, Togus
WIEEIAMS, EDMUND P., Oakland
WIEEIAMS, FRANCIS T.,
Veterans’ Administration, Togus
YOUNG, WIEEIAM J,,
Yonkers, N. T.
KNOX COUNTY
OFFICERS
President, James Carswell, Jr., Camden
Vice-President, Herman J. Weisman, Rockland
Secretary-Treasurer, Abbott J. Fuller, Pemaquid
MEMBERS
BROWN, FREEMAN F., 5 Beech St., Rockland
CAMPBEEE, FRED G„
CARSWEEE, JAMES, JR.,
DENNISON, FREDERICK,
EAREE. RAEPH P„
FOGG, NEIE A.,
FOSS, AEVIN W.,
FROHOCK, HORATIO W.,
FUEEER, ABBOTT J.,
Warren
6 Sea St., Camden
151 Main St., Thomaston
Vinalhaven
Rockland
11 Beech St., Rockland
10 Summer St., Rockland
Pemaquid
GREEN, ARCHIBAED F.,
HAEE, WAETER I).,
HUTCHINS, JA3IES G.,
JAMESON, C. HAROED,
JONES, PAUE A.,
KEEEER, BENJAMIN H.,
EEACH, CHAREES H.,
60 Elm St., Camden
407 Main St., Rockland
50 Elm St., Camden
465 Main St., Rockland
Union
407 Main St., Thomaston
Pownal
NORTH, CHAREES D., 38 Union St., Rockland
POEISNER, SAUE, 13
POPPEESTONE, CHAREES B
SHIEEDS, VICTOR H.,
SOUEE, GIEMORE W.,
TOUNGE, HARRY G., JR.,
TWEEDIE, HEDEEY V.,
WASGATT, WESEEY,
WEISMAN, HERMAN J.,
Mountain St., Camden
465 Main St., Rockland
Vinalhaven
80 Broad St., Rockland
12 Union St., Camden
407 Main St., Rockland
7 Talbot Ave., Rockland
76 Limerock St., Rockland
HONORARY MEMBERS
COOMBS, GEORGE H., Waldoboro
LINCOLN - SAGADAHOC COUNTY
OFFICERS
President, Edwin M. Fuller, Jr., Bath
Vice-President, Thus. Proctor, Boothbay Harbor
Secretary-Treasurer, Jacob Smith, Bath
MEMBERS
BARROWS, H, C., 5 Commercial St., Boothbay Harbor
BEEKNAP, ROBERT W’., Damariscotta
BOUSFIEED, CYRIE E., Woolwich
DAY, DeFOREST S., Main St., Wiscasset
FERNAED, H. E., East Boothbay
FUEEER, EDWIN M., 119 Front St., Bath
FUEEER, EDWIN M., JR., 108 Front St., Bath
GRANT, HUGH D., 141 Front St., Bath
GREGORY, PHIEIP O.,
6 Commercial St., Boothbay Harbor
HAMIETON, VIRGINIA C., 900 Washington St., Bath.
KERSHNER, WARREN E., 119 Front St., Bath
EAUGHEIN, J. W.,
EENFEST, STANEEY R.,
MORIN, HARRY F.,
OWEN, AEBERT S.,
PARSONS, NEIE E.,
PRATT, EDWIN F.,
PROCTOR, THOMAS E.,
Newcastle
Main St., Waldoboro
72 Front St., Bath
832 Washington St., Bath
Damariscotta
7 Main St., Richmond
St., Boothbay Harbor
8A McKown
SailTH, JACOB,
SMITH, JOSEPH E,
SNIPE, EANGDON T.,
STETSON, RUFUS E.,
73Va Front St., Bath
73Va Front St., Bath
112 Front St., Bath
Damariscotta
WIEEIAMS, ADEEBERT F., R. F. D., Phippsburg
WINCHENBACH, FRANCIS A.,
910 Washington St., Bath
HONORARY MEMBERS
GREGORY, GEORGE A.,
2 Commercial St., Boothbay Harbor
PARSONS, WIEEIAM H., Damariscotta
OXFORD COUNTY
OFFICERS
President, Albert P. Royal, Rumford
Vice-President, Johnson E. Bean, Norway
Secretary-Treasurer, James S. Sturtevant, Dixfleld
MEMBERS
ADAMS, EESTER,
Western Maine Sanatorium, Greenwood Mt.
ATWOOD, HAROED F.,
AUCOIN, PIERRE B.,
BEAN, JOHNSON E.,
BURR, THOMAS S.,
COHEN, EEON,
COREISS, EEEAND M.,
COURVIEEE, AEBERT E.,
Buckfleld
134 Congress St., Rumford
Norway
Municipal Bldg., Rumford
Fryeburg
West Paris
82 Maine Ave., Rumford
DANIEES, S. DAVID,
Western Maine Sanatorium, Greenwood Mt.
DEFOE, GARFIEED G., Dixfleld
DIXON, WAETER G., Norway
EASTMAN, CHAREES W., Livermore Falls
EESEMORE, DEXTER E., Dixfleld
GREENE, JOHN A., 96 Congress St., Rumford
HOWARD, HENRY M., 105 Franklin St., Rumford
HUBBARD, ROSWEEE E., Waterford
JACKSON, NORMAN M., Andover
KAY, EDWIN, 671 Main St., Lewiston
LAWRENCE, HOMER E., Bethel
LESLIE, FRANK E.,
Veterans’ Adm. Hosp., Mendota, Wise.
MacDOUGAL, JAMES A.,
McCARTY, EUGENE M.,
MOODY, HARRY A.,
MOORE, BERYL M.,
NELSON, CHEESEY W.,
NOYES, HARRIETT L.,
OESTRICH, ALFRED,
PEARSON, HENRY,
ROWE, WILLIAM T.,
ROYAL, AEBERT P.,
240 Waldo St., Rumford
82 Maine Ave., Rumford
150 Congress St., Rumford
Oxford
Norway
63 Congress St., Rumford
Mexico
Center Conway, N. H.
250 Penobscot St., Rumford
82 Main Ave., Rumford
146
The Journal of the Maine Medical Association
SMAI.I.EY, FRED E.,
STANWOOD, HAROED W.,
STAPEES, IVAN W.,
STEWART, DEEBERT M.,
TIBBETTS, RAYMOND R.,
VIEEA, JOSEPH A.,
WIESON, HARRY M.,
HONORARY
BINFORD, HORACE J.,
STURTEVANT, JAMES S.,
Bryant Pond
5 Franklin St., Rumford
Norway
So. Paris
Bethel
So. Paris
Bethel
MEMBERS
Mexico
Dixfleld
PENOBSCOT COUNTY
OFFICERS
President, Albert W. Fellows,
Vice-President, Ernest T. Young-,
Secretary-Treasurer, Forrest B. Ames,
Bangor
Millinocket
Bangor
MEMBERS
ADAMS, ASA C., Main St., Orono
AMES, FORREST B., 489 State St., Bangor
BAYARD, CEAYTON H.,
BEAISDEEE, CARE E.,
BURGESS, CHAREES H,,
BUTEER, HARRY,
Main St., Orono
47 Broadway, Bangor
2.39 Hammond St., Bangor
77 Broadway, Bangor
CEEMENT, JA3IES D., 77 Essex St., Bangor
CEOUGH, DEXTER J., 2ND,
lOGO Madison Ave., Memphis, Tenn.
COMEAU, WIEFEED J„ 48 Penobscot St., Bangor
CRAIG, D. AEEAN, 489 State St., Bangor
DEVAN, THOMAS A.,
10245 47th Ave., Corona, L. I., N. Y.
DUNHAM, RAND A., East Millinocket
EMERSON, W. MERRITT, 131 State St., Bangor
EMERY, CEARENCE, JR., 92 Essex St., Bangor
FEEEEY, J. ROBERT, 3 Third St., Bangor
FEEEOWS, AEBERT W., 45 Ohio St., Bangor
GOODRICH, EDWARD P., Winterport
GUMPRECHT, WAETER R., IIG State St., Bangor
HAEE, WAETER C.,
HAEE, WAETER E. H.,
HAMMOND, WAETER J„
HEDIN, CARE J.,
HEREIHY, EDWARD E.,
HIGGINS, GEORGE I.,
HIEE, AEEISON K.,
HORTON, GEORGE H.,
HOUEIHAN, JOHN S.,
HUNT, BARBARA,
HUNT, HARRISON J.,
Orono
18 High St., Old Town
State Hospital, Bangor
State Hospital, Bangor
159 State St., Bangor
Newport
12 Grove St., Bangor
Hermon
489 State St., Bangor
224 State St., Bangor
162 French St., Bangor
KNOWETON, HENRY C., 47 Broadway, Bangor
EETHIECQ, JOSEPH A.,
EEZBERG, JOSEPH,
EIBBY, HAROED E.,
EOUD, NORMAN W.,
115 Wilson St., Brewer
28 Main St., Bangor
Lincoln
489 State St., Bangor
MADDAN, MARTIN C., Old Town
MANSFIEED, BEANCHE M., 191 State St., Bangor
MASON, EUTHER S., 109 State St., Bangor
McKAY, HUGH G., Old Town
McNAMARA, WESEEY C., Lincoln
McNEIE, HARRY D., 58 Hammond St., Bangor
McQUOID, ROBERT M., 39 Columbia St., Bangor
ailEEINGTON, PAUE A., 44 High St., Newport
MIRAGEIUOEO, LEONARD G.,
253 Hammond St., Bangor
MOISE, THEODORE S.,
MOULTON, MANNING C.,
MUNCE, RICHARD T.,
OSEER, JAY K„
42 Fourth St., Bangor
150 State St., Bangor
205 French St., Bangor
150 State St., Bangor
PEARSON, JOHN J.,
PETERS, WILLIAM C.,
PURINTON, WATSON S.,
PURINTON, WILLIAM A„
Old Town
45 State St., Bangor
15 Ohio St., Bangor
39 High St., Bangor
RIDEON, MAGNUS P., 99 Broadway, Bangor
ROBINSON, HARRISON E., 136 Hammond St., Bangor
RUHEIN, CARE W., 268 State St., Bangor
SANGER, EUGENE B.,
SANTORO, DOMINICO,
SCHRIVER, ALFRED H., 16
SCHURMAN, HANS,
SCRIBNER, HERBERT C.,
SHERRARD, FREDERICK D.
SIESBY, SAMUEL S.,
SKINNER, PETER S.,
SKOEFIELD, EZRA B.,
SMALL, AMOS E.,
SMITH, J. ELDRED,
SMITH, EeROY H.,
STEBBINS, ARTHUR P.,
STROUT, ARTHUR C.,
111 State St., Bangor
Millinocket
Parkview Ave., Bangor
Dexter
259 Union St., Bangor
, Mattawamkeag
11 Ohio St., Bangor
112 Ohio St., Bangor
East Corinth
31 Central St., Bangor
156 State St., Bangor
Winterport
State Hospital, Bangor
Dexter
TAYLOR, CORNELIUS J.,
TAYLOR, HERBERT E.,
THERIAULT, LOUIS E.,
THOMAS, CALVIN M.,
THOMPSON, HERBERT E.
THOMPSON, JOHN B.,
TODD, AEBERT C.,
VICKERS, MARTYN A.,
18 State St., Bangor
Dexter
Old Town
142 N. Main St., Brewer
, 489 State St., Bangor
23 Hammond St., Bangor
410 S. Main St., Brewer
268 State St., Bangor
WEATHERBEE, GEORGE
WEBBER, MERLON A.,
AVEISZ, HANS,
WEYMOUTH, FRANK D.,
WHALEN, HENRY E.,
WHITWORTH, JOHN E.,
WOODCOCK, ALLAN,
WRIGHT, EaFOREST J.,
YOUNG, ERNEST T.,
B., Hampden Highlands
Pittsfield
Howland
46 No, Main St., Brewer
Dexter
49 Hammond St., Bangor
35 Second St., Bangor
39 W. Broadway, Bangor
Millinocket
PISCATAQUIS COUNTY
OFFICERS
President, Fred J. Prltham, Greenville Jict.
Vice-President, Albert M. Carde, Milo-
Secretary-Treasurer, Norman H. Nickerson, Greenville
M E 31 B E R S
BR03VN, 3IAURICE O.,
BUNDY, HARVEY C.,
Dover- Foxcroft
Milo
CARDE, AEBERT 31.,
CURTIS, JOHN B.,
DORE, GUY E.,
HOWARD, GEORGE C.,
3IacDOUGAE, 3VIEBUR E.,
3IARSH, BURTON S.,
3IARSH, RALPH H.,
NICKERSON, NORMAN H.,
PRITHAM, FRED J.,
STANHOPE, CHAREES N.,
STUART, RALPH C.,
TH03IAS, RUTH B.,
VALENTINE, JOHN B.,
Milo
Milo
Guilford
Guilford
Dover-Foxcroft
Greenville Junction
Guilford
Greenville
Greenville Junction
Dover-Foxcroft
Guilford
Dover-Foxcroft
Dover-Foxcroft
honorary
CROSBY, NATHANIEL H.,
3IERRILE, EE3IER D.,
31 E M B E R
Milo
Dover-Foxcroft
SOMERSET COUNTY
OFFICERS
President, Allan J. Stinclifield, Skowhegan
Vice-President, 3Iaurice S. Pliilbrick, Skowhegan
Secretary-Treasurer, 3Iaurice E. Lord, Skowhegan
31 E 31 B E R S
BALL, FRANKLIN P., Bingham
BERNARD, AEBERT J,, 198 Madison Ave., Skowhegan
Nineteen Hundred and Forty-two — June
147
BRIGGS, PArn R.,
CAZA, ORIVER J.,
DOE, HARVEY E.,
EAREE, FRED E.,
GIEBERT, PERCY E.,
HEMPHREYS, ERNEST D.,
HETCHINS, EUGENE E.,
Hartland
North Ave., Skowhegan
Lawrence Ave., Fairfield
Weeks Mills
Madison Ave., Madison
91 Main St., Pittsfield
No. New Portland
EANEY, RICHARD P.,
EORD, MAURICE E.,
MARSTON, HENRY E.,
MIEEIKEN, WAETER S.,
NORRIS, EESTER E.,
PHIEBRICK, MAURICE S.
REED, HOWARD E.,
SO Water St., Skowhegan
220 Water St., Skowhegan
No. Anson
35 Maple St., Madison
Maple St., Madison
292 Water St., Skowhegan
43 Western Ave., Madison
STINCHFIEED, AEEAN J.^,
132
STINCHFIEED, WAETER
SUEEIVAN, GEORGE E.,
Madison Ave.,
S., Court St.,
Skowhegan
Skowhegan
Bingham
WAETERS, WIESON H., 16 Summit St., Fairfield
YOUNG, GEORGE E., Water St., Skowhegan
honorary
EEEINGWOOD, EOUIS N.,
MOUETON, CHAREES A.,
ROBINSON, FRANK J.,
MEMBERS
Athens
Hartland
Fairfield
WALDO COUNTY
OFFICERS
President. Eester R. Nesbitt, Bucksport
Vice-President, Foster C. Small, Belfast
Secretary-Treasurer, Raymond E. Torrey, Searsport
M E M
CASWEEE, JOHN A.,
JONES, RICHARD P.,
EARRABEE, BURTON E.
MIEEER, GEORGE F.,
NESBITT, EESTER R.,
PATTEE, SUMNER C.,
SMAEE, FOSTER C.,
STEVENS, CARE H.,
STEVENS, EUGENE E.,
TAPEEY, EUGENE D.,
TORREY, RAY3IOND E.,
; E R S
130 Main St., Belfast
5 Franklin St., Belfast
19 High St., Belfast
27 Northport Ave., Belfast
Elm St., Bucksport
5 Northport Ave., Belfast
169 High St., Belfast
1 Court St., Belfast
38 Church St., Belfast
17 High St., Belfast
West Main St., Searsport
WASHINGTON COUNTY
OFFICERS
President, Perley J. Mundie, Calais
Vice-President, Herbert H. Best, West Pembroke
Secretary-Treasurer, James C. Bates, Eastport
M E 31 B ]
AR3ISTRONG, CHAREES 31
BATES, JA3IES C.,
BENNETT, DaCOSTA F„
BEST, HERBERT H.,
BROGAN, AUSTIN J.,
BUNKER, WIEEARD H„
CAPPEEEO, JOSEPH,
COBB, NOR3IAN E.,
CRANE, JAMES AV.,
DYAS, AEEXANDER D.,
GIEBERT, AVAETER J.,
HANSON, JOHN F.,
JACOB, DONAED R.,
EARSON, OSCAR F.,
3IINER, AVAETER N.,
3IUNDIE, PEREEY J.,
AA'EBBER, SA3IUEE K.,
E R S
Robtainston
Eastport
Lubec
AVest Pembroke
Hines, 111.
Calais
27 Main St., Lubec
Calais
Woodland
St. Stephen, N. B.
Calais
Machias
Princeton
Machias
Calais
Calais
Calais
HONORARY
BENNETT, EBEN H.,
HUNTER, SARAH E.,
3IcDONAED, JOHN A.,
AA^HITE, ERNEST A.,
31 E 31 B E R S
Lubec
Machias
East klachias
Columbia Falls
YORK COUNTY
OFFICERS
President,
Carl E. Richards,
.Alfred
Afice-President,
Arthur J. Stimpsoii,
Kennebunk
Secretary-Treasurer, Charles AA'. Kinghorn, Kittery
31 E 31
AEEEN, PEINY A.,
BAKER, AVIEEIA3I H.,
BEE3IONT, RAEPH S.,
COBB, STEPHEN A.,
COOK, EDAA’ARD 31.,
CORBETT, AVIEEIAM F.,
CUNEO, KENNETH J.,
DAAIS, ANSEE S.,
DENNETT, CARE G.,
DOEEOFF, DAA'ID E.,
DOAANING, J. ROBERT,
EEEIOTT, AA IEEIA3I T.,
HEAD, OAA EN B.,
HIEE, PAEE S., JR.,
HIEE, PAUE S.,
JONES, ARTHUR E.,
E R S
York Harbor
AA^est Buxton
207 Main St., Sanford
28 AVinter St., Sanford
York Harbor
Sanford
Kennebunk
Springvale
Saco
13 Crescent St., Biddeford
37 Storer St., Kennebunk
Berwick
6 AVashington St., Sanford
Saco
Saco
Old Orchard
KEEEY, AVIEEIA3I H., Wolf Building, Sanford
KINGHORN, CHAREES W., Kittery
EA3IOUREUX, ARTHUR C.,
EaROCHEEEE, JOSEPH R.,
EIGHTEE, AVIEEIA3I E.,
EORD, FREDERICK C.,
EOAE, GEORGE R.,
102 Main St., Sanford
42 Bacon St., Biddeford
No. Berwick
260 Main St., Biddeford
Saco
3IACDONAED, JA3IES H.,
3IAHANEY, AAHEEIA3I F.,
3IAZZACANE, WAETER D.,
3IORSE, WAEDRON E.,
3IOUETON, 3I.VRION K.,
3IURPHY, JOHN J.,
Kennebunk
Saco
Old Orchard
Springvale
AA^est Newfield
AVells Beach
NE3ION, EEON,
O’GARA, E3I3IET F.,
OAA EN, HERBERT A.,
O’SUEEIA AN, AA IEEIA3I
PERRAUET, OSCAR,
PRESCOTT, HARRY E.,
RICHARDS, CARE E„
ROSS, FRANK A.,
ROSS, HAROED D.,
ROUSSIN, AAHEEIA3I T.,
243 State St., Portland
So. Berwick
Bar Mills
B., 340 Main St., Biddeford
20 Jefferson St., Biddeford
Kennebunkport
Alfred
So. Berwick
28 AVinter St., Sanford
48 Bacon St., Biddeford
S3IAEE, FITZ E.,
S3I1TH, GERAED R.,
S3IITH, AAHEEIA3I AV.,
STICKNEY, EAURA B.,
STI3IPSON, ARTHUR J.,
260 Main St., Biddeford
Ogunquit
Ogunquit
Saco
Kennebunk
TH03IPSON, CEARENCE E.,
Saco
A’ACHON, ROBERT D., 50 AAhnter St., Sanford
AVEBBER, E. DEAN, Kittery
AA lEEY', ARTHUR G., Bar 3Iills
XAPHES, CHRYSAPHES J., 107 Main St., Biddeford
HONORARY 3IE3IBERS
GORDON, JOSEPH AV., Ogunquit
SHAPEEIGH, EDAVARD E„ Kittery
XIII
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Portland, Maine
DIAL 2-4678
The Journal
of the
Maine Medical Association
Uolume Thirti^^lhree Portland, Ulaine, Juli], 1942 No. 7
Presidential Address'^'
By P. L. B. Ebbett, M. D., Hoiilton, Maine
I fully appreciate the honor my position,
as President of the Maine Medical Associa-
tion, affords me of welcoming yon to this, the
90th animal session of onr Association. I de-
sire to thank onr distinguished guests who
have contributed so mnch to the success of
our meeting. I also wish to thank the mem-
bers of the Scientific Committee who have
worked very hard to give ns an excellent pro-
gram ; also all others who have taken part in
the conferences and other divisions of the pro-
gTam. My thanks go also to the officers, mem-
bers of the Council and various committees
who have cooperated so diligently in carrying
on the work of the Association during the
past year. Every man I have called on has
accepted the task asked of him and performed
it in an excellent manner. Without the assist-
ance of these men who contributed so freely
of their time I would have been helpless. I
now feel, however, thanks to the excellent
work of my predecessors and of my associ-
ates, that during the year the affairs of the
Association have progTessed very favorably.
I am especially grateful to onr Secretary, Dr.
Carter, and his assistant, Mrs. Kennard, who
in spite of having so mnch other work were
always ready to help in every possible
manner.
Another to whom I feel mnch indebted is
not a member of onr profession. I refer to
]\rr. Herbert Locke, who has been very active
in onr interests in legislative affairs and who,
by his 23ersevering efforts, was able to obtain
legislative decisions of mnch benefit to our
Association.
Probably at no time in the history of onr
Association have we been confronted by such
momentous problems as we are facing today.
The Government is calling onr boys to mili-
tary service and it is up to the Medical Fra-
ternity to provide them with adequate medi-
cal care. Military authorities state that they
need 6^^ doctors for every 1,000 men, where-
as in civilian life they estimate IV2 doctors
can care for 1,000 men. Ho doubt the
doctors per 1,000 men in service will be ob-
tained but are we going to have 114 doctors
jDer 1,000 civilian population left to take care
of that gronj) ? The task that falls on the
shoulders of the older men who cannot enter
military service will not be a light one, but
the Medical Profession has never yet fallen
down in rendering service when service was
needed and I have no doubt we will in some
way be able to surmount the obstacles which
now seem like almost impassable barriers.
* Presented at the 90th Annual Session of the Maine Medical Association, at Poland Spring, Maine,
June 23, 1942.
150
The Journal of the Maine Medical Association
I am told by Military circles that our
young men are not coming to the front and
enlisting in anything like the numbers
needed. If this is so, it is very regrettable
for when our young laymen are fighting for
the preservation of Democracy and our Na-
tional life and honor, we certainly should do
all in onr power to aid them. We older men
have been told that we are not wanted because
they fear we could not stand np under the
hardships we might be exposed to and would
have to be cared for ourselves, but this does
not apply to onr younger men who are physi-
cally qualified for service. Young men don’t
give the Military a chance to say the mem-
bers of our profession are slackers ; that we
are not doing onr part in keeping our Nation
safe for Democracy. We, of the profession,
know that this is not so but we have yet to
prove it to the people at large. If Uncle Sam
wants 6Y2 doctors for every 1,000 men he
will surely get them, but I would very much
prefer to see him get them by voluntary en-
listment, rather than by compulsory draft.
As I said before, those of onr profession
who are not acceptable for Military service
will find our work very much harder and we
will need to plan how we can best care for the
civilian population. Not only must we be
ready to care for the o:
ditions which arise, but we must be prepared
for emergencies of all kinds. Sliould tliese
be war casualties due to bombing, sabotage,
etc., we could probably take care of such con-
ditions because we could get help from areas
which had not been afflicted with such calami-
ties, but what if an epidemic occurred whicli
was nation-wide, then we would have to stand
on our own feet as the Doctors in other com-
munities would have similar difflculties to
contend with. We must plan and be prepared
to meet such eventualities as may arise and
where is there a better place to plan than here
at our State of Maine Medical Meeting ? Let
us discuss these possible emergencies at onr
business meetings. Let us gather suggestions
from each other. Let everyone take part for
we are all concerned. The problems we will
have to contend with will vary greatly. They
will differ greatly as to location. Portland’s
L’dinary medical con-
problems will not be like those of a rural com-
munity. The problems of Aroostook and Pis-
cataquis will not be similar to those of Kenne-
bec or Androscoggin which are much more
thickly populated, thus permitting a doctor
to attend many more patients. Each locality
will have many like problems but all will
vary to- some extent. In Aroostook, the long
distances and the poor roads are going to be
hard on tires. The allocation of passenger
car tires for southern Aroostook, i.e. from
Mars Hill south, for the month of May was
3 tires. Now how far would these go even if
doctors got them all ? If we cannot get tires
for onr automobiles we certainly cannot take
care of the civilian population. This is per-
haps a minor matter but it needs considera-
tion. If we have epidemics we will need to
have centralized stations for caring for them
so that one Doctor can care for many more
patients. Have we already planned for such
stations ? If not, we shoidd do so at once so
that, when and if the emergency arises, we
will be prepared to work and take care of it.
Our Nation was not prepared for war and
we are now pajfing the penalty for such un-
prejDaredness. I hope and trust the Medical
Profession will not find itself in a similar
condition. If we, as a body, get together and
prepare for whatever disasters may arise I
know that we can overcome them. In the past
the profession has always given its best and
has never failed when Uncle Sam called. He
is calling on us now more urgently than ever
before and again I know the medical profes-
sion is going to come through 100% efficient.
In the words of the song, “We have done it
before, and we can do it again,” we will do
it again.
In closing, I wish to say to my successor in
office that I hope he will enjoy his work as
much as I have and to assure him that I shall
always be ready to assist him in any possible
way I can, just as he has assisted me during
the past year. Again I desire to thank you
all for your forbearance with my mistakes,
for your many courtesies, and for your very
generous assistance during my year as Presi-
dent of your Association.
Nineteen Hundred and Forty-two — July
151
The Central Maine Blood and Plasma Bank
Plan for' Blood and Plasma Banks, State of Maine: Part II
Julius Gottlieb, M. T3., F. A. C. P.,
Lt. Gilbert Clappertojst, M. C., U. S. A.
Bertha Wood Emohd, R. N".
In a recent publication (Part I),^ the
writers presented a general plan for blood
and plasma banks for the State of Maine in
which the establishment of three central
banks was recommended, each to serve pri-
marily as the processing center for a group of
regional banks, covering approximately one-
third of the state area. This paper deals with
a detailed description of the organization of
the Central Maine Blood and Plasma Bank,
including the conduct of a blood donor clinic,
and the technic employed in the collection,
processing, storage and dispensing of blood
plasma.
Donor Procurement :
To a donor procurement committee is as-
signed the duty of obtaining lists of volun-
teers and to arrange for appointments for
blood donor clinics. Donors were readily ob-
tained by consulting the national defense
cards, and as a result of making known the
need for donors to the various local organiza-
tions, and announcement of activities of the
^ Part I — Plan for Blood and Plasma Banks,
State of Maine, Me. Med. J., V. 33, No. 4, April,
1942, pp. 81-83.
bank through the local newspapers. Each
prospective donor is notified to appear at a
certain indicated time with the following in-
structions : Blood donors are not to eat for at
least four hours jnfior to appearance at the
blood donor clinic. If, however, the donor is
hungry, he may take the following: Coffee
or tea with sugar, but without milk or cream ;
orange juice or any clear fruit juice ; toast,
bread or crackers without butter ; no ice
cream, chocolate malted milk, etc.
Blood Donor Clinic :
The blood donor is registered, is referred
to a technician, who obtains a hemoglobin
estimate, temperature, and blood cells for
blood-grouping, and is then referred to a
physician for a brief history and physical ex-
amination. The physician assumes responsi-
bility for acceptance or rejection and indi-
cates the amount of blood to be withdrawn.
Donor’s registration card must be fully com-
pleted. On the reverse side of this card is a
legally sealed contract, previously signed by
donor, and witnessed by the registrar.
(Forms are presented on next page).
152
The Journal of the Maine Medical Association
Date
Time
M.
BLOOD AND PLASMA BANK FUND
Collection Station
DoNoNs REGISXrtATION Cai?d
No
Group
Color
(International)
Last Name
First Name
Age:
Street and Number
City
Sex: ...
State
Phone No.:
Intended for: Patient: ....
Temp.: Pulse:
HISTORY:
Asthma?
Malaria?
Tuberculosis?
Syphilis?
Any serious Illness? ..
Illness in last Month?
Persistent Cough?
Remarks :
Last Donation: Hours since last meal:
□ Defense □ Unrestr.
Hemoglobin: % Weight: Blood Pressure:
EXAM:
Pain in Chest? Skin
Coughed up Blood? Mouth
Shortness of Breath? Pharynx
Swelling of Feet? Heart
Convulsions? Lungs
Fainting Spells? Serology by
Recommended that c.c. be taken. Amount taken c.c.
Reaction of Donor to Phlebotomy:
Signed: M. D.
(Keveese Side)
BLOOD AND PLASMA BANK FUND
Cewteal Maine Geneeal Hospital
Lewiston, Maine
I am voluntarily furnishing blood through the Central Maine General Hospital for its use, and for
use by others to whom it may be entrusted, either as blood or plasma, in the treatment of patients, and
for that purpose I am at my own risk submitting to the tests, examinations and procedures customary in
connection with donations of blood. I agree that neither the Central Maine General Hospital nor any
surgeons, physicians, technicians, nurses, agents or officers connected with any of them, or who may be
participating otherwise in this work, shall be in any way responsible for any consequences to me resulting
from the giving of such blood or from any of the tests, examinations or procedures incident thereto, and
I hereby release and discharge each and all of them from all claims and demands whatsoever which I, my
heirs, executors, administrators or assigns have or may have against them or any of them by reason of any
matter relative or incident to such donation of blood, and I hereby agree that said Hospital may use or
permit the use of said blood or plasma in any way deemed by it to be advisable for the benefit of persons
in need of such treatment, or to create a reserve in its hospital or elsewhere for such needs.
IN WITNESS WHEREOF I have hereunto set my hand and seal this
day of 194
(Legal Seal)
In the presence of
Nineteen Hundred and Forty-two — July
153,
PHLEBOTOMY SET
Collection of Blood:
Phlebotomy set (See diagram -Xo. 1) :
At this center the Fenwal collecting
flask is employed, and the set contains : A
Fenwal flask, 500 c.c. capacity, complete
with rubber bushing (also referred to as a
stopper or cap) and stainless steel cap, con-
taining 60 c.c. of 2% Sodium Citrate
solution.
Ravitch donor vent tube, complete Avith
intraA^enous tubing attached. To one arm
of vent tube is attached rubber tubing,
short, at the end of Avhich is a glass con-
necting tube filled Avith cotton for air vent.
To the other arm of the vent tube (donor
arm) is attached a longer rubber tubing,
at the end of which is attached a LeAvisohn,
15 G. needle, encased in a glass test tube,
held in place Avith a rubber band.
Muslin shield with hole in center
through which extends the Ravitch tube.
Hoffman clamp.
Hypo needle.
Medicine glass (containing hypo needle
and small piece of gauze).
Ho. 11 B-P abscess blade contained in a
stoppered tube (point of blade in a stop-
per).
Fxtra cork stopper for needle encase-
ment tube, for serology sample.
The phlebotomy set is Avrapped in a towel,
placed in a tin can, measuring 7" high and
6" Avide, about Avhich is a canton flannel bag.
The bag and its contents are referred to as
the donor set, and is sterilized by autoclaAdng
at 15 lbs. of pressure for 30 minutes. Simi-
lar sets are provided to each of the associated
blood donor clinics.
Preparation of Donors :
The donor assumes a recumbent position,
with the selected arm bared to the shoulder,
and extended in a position suitable to the
operator. A rubber sheet and sterile towel is
placed under the arm, a soft rubber tourni-
quet is placed in position for application
immediately prior to the phlebotomy. The
154
arm is scnil>l)ed with soaj3 and water for two
minutes, using gauze on sponge forceps, fol-
lowed by Alcohol and Tincture of Zephiran.
Piileboto:my :
The donor set is unwrapped, the metal cap
is removed and placed stem downward, rim-
ming the medicine glass, thus keeping stem
and inner surface of cap sterile. Care is
taken not to contact the rnbher hushing in
the flask. Donor tube is inserted in bushing
and sterile muslin shield is drawn down over
rubber bushing and secured with elastic l)and.
Tubing on air vent is clamped, flask is in-
verted, allowing a small amount of citrate to
moisten delivery tube and needle, as well as
the entire inner surface of the flask. Hypo
needle is attached to a master syringe contain-
ing 1% ISTovocain, tourniquet is applied and
a small skin wheal is raised over the chosen
vein. Veins must not be palpated by opera-
tor, despite his sterile preparation. The
operator scrubs for ten minutes before the
first bleeding and for two minutes between
cases. The skin overlying the vein may be
pierced directly with needle, or with abscess
knife blade, effecting a small nick in the skin
with an upward motion. After venepuncture,
the blood is allowed to flow by gravity with
donor rhythmically opening and closing his
fist, at a rate of about fifteen per minute.
Suction is applied only when needed.
When desired amount of blood is obtained,
a Hoffman clamp is placed on delivery tube,
close to glass donor tube, slightly distal to
which, allowing space for scissors blade, a
straight clamp is applied and tubing cut be-
tween. With tourniquet on, and needle in
place, the clamp is released and test tube for
serology is filled. Clamp is reapplied, tourni-
quet released, needle withdrawn, and a sterile
dressing placed at site of venepuncture and
dressing fixed with Elastoplast, for twenty-
four hours.
Attention is then directed to collecting
apparatus. Sterile apron is lifted upward,
away from rubber cap, enveloping the glass
donor tube. With a quick pull directly up-
ward, the Ravitch tube is removed from the
rubber stopper. The metal cap is now re-
placed by a quick, firm push, sealing the
flask. The last two procedures must follow
The Journal of the Maine Medical Association
each other quickly to avoid the possibility of
air-borne bacteria entering flask.
All tubing and needles coming in contact
with blood are taken immediately to utility
room and rinsed with cold tap water. Flask
and serology tube are labeled and placed in
refrigerator at 4° C.
Donor remains in recnmbent position for
at least ten minutes, and is then permitted
to sit np for a few minutes, following which
he is escorted to adjoining room for nourish-
ment, unless some untoward symptoms are
presented. Faintness may be overcome, by
elevating the foot of the bed twelve inches,
and the administration of Aromatic Spirits
of Ammonia (1 dr. in a glass of water).
PoonixG OF Plasma:
Blood cells are permitted to settle from
three to five days in the refrigerator, during
which period, serological tests have been com-
pleted, and the blood groups determined. In-
sofar as possible, all blood groups should be
represented in each of the pools. It is recom-
mended that pools shall be comprised only of
such bloods obtained from one institution and
that no intra-pooling be practiced from col-
lections of various hospitals. In a cooperative
type of bank, this enables a check on the
sources of contamination, if found. Pooling
is accomplished in an ultra-violet cabinet by
properly masked and gowned technicians.
Pools contain from five to ten single blood
collections. The plasma of each collection
flask is aspirated into a 2,000 c.c. Fenwal
flask, by means of a nine-inch aspirating
needle, employing a Gomac suction appa-
ratus.
Each pool is cultured for both aerobes and
anaerobes, employing nutrient broth for the
former and Brewer’s media for the latter.
Cultures are carried on for two weeks at
37.5° C. Plasma is stored in Arctic trunks
immediately after transferring into the Bax-
ter Centri-Vac flasks. If lyophilizing is con-
templated, the shelling process should be em-
ployed. Plasma frozen by this method may
be rendered liquid again and shelled, should
lyoj)hilizing become advisable. Each flask is
carefully labeled according to a pooling
series.
Nineteen Hundred and Forty-two — July
155
Syringe attached here
Technic foh Pooeing of Plasma (Sec Hia-
grams No. 2 and 8) :
Workers before pooling must scrnl), wear
masks and gowns. Plasma is pooled into a
2,000 c.c. Fenwal flask with rubber bnshing
in place, tlirongh which is inserted a Ravitch
recipient vent tube. A 9-inch aspirating
needle which is connected by a rubber tube
to tlie recipient arm of the Ravitch tube is
inserted into the supernatant plasma. A
vent tube (connecting tube with cotton filter )
is attached to the suction tube by means of
long rubber tubing, and to the other arm of
the Ravitch tube by a short tubing (see dia-
gram). Care must be taken not to aspirate
the red cells. When the desired amount is
obtained in the pooling flask, aspirating tube
is detached from Ravitch tube, the end of
which is flamed before attaching a short rub-
ber tnbiiig to which is fixed a 20 c.c. syringe,
employed for withdrawal of 10 c.c. of plasma
for inoculating culture tubes. The Ravitch
tube is now removed from the rnliber bush-
ing, and replaced by metal cap, tlins sealing
flask. Both rubber bushing and stem of metal
cap are flamed immediately preceding con-
tact.
Pooled plasma is now allowed to stand for
twenty-four to forty-eight hours, thus permit-
ting the settling of red cells, inadvertently
aspirated into it.
The plasma is now transferred into storage
flasks. In this laboratoiy the Baxter Centri-
Pooling to storage flask
Diagram No. 3
156
The Journal of the Maine Medical Association
vac flask is employed. The procedure is as
follows : An eleven-inch aspirating needle is
inserted throngh tlie liole of the rubber hush-
ing after removal of metal cap and flaming;
this needle being attached to a rubber tube,
which is connected at the other end to a Bax-
ter valve needle. The Baxter flask is pre-
pared by removing metal protection cap and
rubber disc, exposing a rubber cap which is
visible through the remaining diaphragm.
The Baxter needle is plunged through a pre-
pared site marked “X,” the valve is opened,
until the desired amonnt of plasma is ob-
tained, which is usually from 400 to 500 c.c.
The valve is now closed, and the Baxter
needle removed. Plasma is now ready for
freezing and storage in an Arctic Trunk at
20° C. below freezing. These are released
for nse — only after the bacteriological cul-
tures have proven negative after two weeks’
incubation. For dispensing plasma, the Bax-
ter dispensing tubes are recommended. When
not availalfle, the nsTial gravity tnbes may be
employed and filter improvised by using
layers of gauze.
Note: The writers wish to express their grati-
tude to Dr. John Scudder, Presbyterian Hospital,
New York, N. Y. ; Dr. Frank Barton, Massachusetts
Memorial Hospitals, Boston, Mass.; Dr. William
Dameshek, Tufts Medical School faculty, Boston,
Mass.; for their guidance, instruction and encour-
agement.
Bingham .Hospital Extension Service, Cen-
tral Maine General H(jspital, Lewiston,
Maine.
Appendix :
Care of Equipment
Care of Intravenous Equipment at time of
purchase :
Bushings:
1. Cover rubber bushing with 0.5% So-
dium Carbonate Solution.
2. Autoclave for 30 minutes.
3. Binse with hydrochloric acid 1%.
4. Rinse with distilled water until neu-
tral to litmus paper.
5. Place in clean, covered containers un-
til ready to use.
Rubher Tubing:
1. Cover rubber tubing with 0.5% So-
dium Carbonate Solution.
2. Be sure to have some of the Sodium
Carbonate solution rnn through the
inside of the tubing.
3. Autoclave for 30 minutes.
4. Rinse with hydrochloric acid 1 % hav-
ing some acid rnn throngh the inside
of the tnbing.
5. hiinse with distilled water.
0. Rnn distilled water throngh tnliing
until neutral to litmus paper.
7. Tubing is now ready to be cut in de-
sired lengths and used.
Care of Intravenons Ecpiipment after Use:
Flash's:
1. Rinse with tap water.
2. Clean in washing machine.
3. Rinse with distilled water either six
times by hand or four times with
Fenwal Rinser.
4. Invert in rack.
5. Flasks are now ready for solutions.
G. If flasks stand more than two hours,
the cleaning process must be repeated.
Metal Caps:
1. Wash in hot soapy water.
2. Rinse with cold water.
3. Rinse with distilled water.
4. Place in a clean covered container un-
til time for use.
5. Rinse with distilled water just prior
to use.
Rubber Bush ings:
1. Wash rubber caps in hot soapy water.
2. Rinse with cold tap water.
3. Boil in sodium hydroxide 0.5% for
45 minutes.
4. Rinse with distilled water until neu-
tral to litmus paper.
5. Place in a clean covered container un-
til ready for nse.
6. Rinse bushings in distilled water just
prior to use.
hitravenous Tubing:
1. Disconnect tubing from glassware.
2. Run cold tap water through tubing to
remove blood.
Nineteen Hundred and Forty-two — July
157
3. Clean in washing machine for one
minute.
4. Connect tnl)ing jnst cleaned together
with glass connectors.
5. Run distilled water through tubing
until neutral to litmus paper.
6. Do not dry tubing.
7. Assemble sets with tubing while still
wet.
Vent Tithes:
1. Rinse vent tTibes and connecting tubes
with cold water to remove blood.
2. Place in a jar of cleaning solution for
at least six hours.
3. Remove cleaning solution from glass-
ware with aid of suction by sucking
distilled water through each piece
separately.
4. Place in a clean covered container un-
til ready for use.
Needles:
1. Run cold water through each needle
with a syringe or bulb.
2. Run stylet through each needle.
3. Run hot soapy water through each
needle.
4. Run cold water through each needle.
5. Run distilled water through each
needle.
G. Run acetone through each needle.
7. Test all needles for hooks and prints.
8. Place in a clean container until ready
to use.
Donor Sets Contain:
1. Rubber tubing, as previously de-
scribed.
2. Ravitch donor tube (complete with
Muslin shield and rubber band).
3. 1 Lewisohn needle, 15 G.
4. Test tube covering above needle (the
two held together with rubber band).
5. Cotton filled vent tube.
G. 1 Medicine glass.
7. 1 sponge.
8. 1 Hypo needle.
9. 1 Hoffman clamp.
10. 1 Fenwal Pyrex Flask, complete with
rubber bushing and metal cap, and
containing citrate sol. Wrap in towel,
place in tin can covered with canton
flannel bag ; tie bag, and autoclave for
30 minutes at 15 lbs. pressure. Upon
removing sets from autoclave, flasks
are sealed by pushing metal caps
down with a quick, Arm push (this is
done without opening set).
Addexuum
Since this paper has been prepared, the
following two procedures have been added :
1. Centrifuging of blood, replacing sedi-
mentation. By this process, a greater yield
of plasma, approximating 10%, is obtained,
as well as the acceleration of plasma separa-
tion. This affords an opportunity for better
preservation of antibodies and complements.
The ap2)aratus employed is the International
Centrifuge and the Fenwal collecting cen tri-
flasks.
2. The Seitz Filter. This is employed for
clearing of cloudy plasma and to insure ste-
rility in questionable contaminated pools.
The final eradication of tuberculosis is
dependent on the eradication of the foci
from which it is spread, and the family of
the patient wih tuberculosis must be care-
fully studied.- — J. G. Bohoefoush, M. D.,
and Pauline Michael, Amer. Rev. of
Tuber., Oct., 1940.
Dust .swept under the sofa disturbs no
one — until it is discovered — nor does
tuberculosis hidden from the public view.
Pulmonary tuberculosis may still masquer-
ade as chronic bronchitis. — F. G. Chandlek,
Lancet, June 8, 1940.
158
The Journal of the Maine Medical Association
Rhinology and Otology
By Lloyd H. Berrie, M. D., Caribou, Maine
A BRIEF SUMMARY OP SOME COMMON DISEASES
The most frequently infected part of the
body is the nasal cavity. The role of the
mucous membrane lining of the nasal cavity
has been treated too lightly as an important
factor concerning the induction of infection
and of health maintaining respiration. This
membrane secretes, normally, a thin mucons
which is propelled towards the nasopharynx
by the cilia of the ciliated epithelium. The
function is twofold. First, invaders, whether
the virus or other organisms, cannot gain a
foothold. Second, about one liter of moisture
in 24 hours is liberated to be taken up by the
inspired air.
It has been established that should there
be an arrest of mncous secretion of an hour
or two, sufficient break in the mucous resist-
ance occurs which may permit invasion by in-
fective agents. When ciliary action is para-
iized the same result obtains. And also, when
blocking of the nasal air passages occurs suffi-
ciently to cause partial or complete mouth
breathing, trouble begins. It is because of
the latter that the “adenoid” child is under-
nourished, anemic and often dull. Eveji
among adults where neglected cl ironic ob-
struction persists the individnal is very apt
to be cachectic.
It follows, therefore, that by simple reason
we ninst not interfere with normal mucosal
action by using nasal medication and surgery
indiscriminately, and should seek to avoid
agents that interfere with mncous secretion
and ciliary activity. It might lie well here to
mention the common imposition pnt upon the
nincons membrane by the dry and central
heating units which are prevalent throughont
the country.
Adenoidectomy, when indicated, is of ut-
most importance for a child’s normal develop-
ment. It is the striking clinical improvement
in the physical and mental development of a
mouth-breathing child who has been freed of
nasal obstruction that most clearly brings
home the value of humidified breathing ; and
that means normal nasal breathing.
The most frequent complication of intra-
nasal disease is sinusitis which may be puru-
lent ; cystic, as with polyps ; allergic and
mixed types.
In the acute purulent forms the offending
organism is most often the streptococcus or
the pneumococcus. In the chronic forms the
organism usually responsible is the staphlo-
coccus anreus and the staphlococcus albus. It
is well to remember these if chemotherapy
reaches a stage where it will benefit sinnsitis ;
and that is a most probable thing.
Sinnsitis arises from vasomotor abnormali-
ties that cause anemia and change in the
mucous covering of the membranes ; inter-
ference with ciliary movements whether due
to toxins, drugs or drying action ; mechanical
blocking, and unfavorable environmental con-
tacts or conditions.
The following are some important funda-
mentals: 1. There seldom occurs an isolated
infection of one sinns alone. Sinuses belong-
ing to the anterior group are generally
affected togetlier ; likewise the posterior
group. 2. Pain is relatively rare in inflam-
mation of the sinns with the exception of the
frontal. 3. Profuse mucopurulent discharge
accompanying a coryza is positive evidence of
an acute sinusitis, and intermittant purulent
discharge is characteristic of chronic sinnsi-
tis. 4. A considerable postnasal discharge is
usually characteristic of iufectioii of the pos-
terior group.
The diagnosis of acute sinusitis is made
by the signs and symptoms of profuse muco-
purulent discharge ; functional blocking of
the nasal passages ; pain or discomfort, and a
general below par feeling. There is usually a
presentation of the discharge at the ostea
ojiening after the nasal cavity has been
cleansed and shrnnk. Direct irrigation may
be performed and the character of the returns
noted. Transillumination is often useful but
is usually unreliable.
The patient with chronic sinusitis com-
plains of frequent “head colds”, an abnormal
Nineteen Hundred and Forty-two— July-
159
amount of nasal discharge; intermittant
Idocking of some degree of the air passages,
a run down feeling. He is often suffering
from extension of the infection to the trachea
and bronchi. Here, X-ray is particularly im-
portant as a diagnostic adjunct. And here,
too, one must always bear in mind the possi-
bility of allergy.
Simple medical and surgical principles of
treatment are the most efficacious in the treat-
ment of sinusitis, as in all diseases. 1. Re-
move the cause. 2. Drain enclosed pus where
possible. 3. Remove diseased tissue when it
is beyond repair, and above all. d. Preserve
as much useful function as possible.
The usual classification of otitis media is
the acute purulent, acnte catarrhal, chronic
])urulent and chronic catarrhal forms.
Acute otitis media almost invariably fol-
lows a coryza of one kind or another or de-
velops from sudden water pressure in the
nose of swimmers who dive. Its development
is assisted l)y abnormalities at the nasal end
of the eustachian tul)e, marked deviation of
the septum and enlarged turbinates.
'iriie organism is usually the pneumococcus
or streptococcus. Outstanding sjmiptoms are
severe pain and diminution of hearing in the
affected ear. There is usually elevation of
temperature. The tympanic membrane, when
the physician gets to see it, is usually beefy
red and is prcjbably l)nlging.
Tiie sensible treatment at this stage is a
clean paracentesis with a sharj) knife. To
temporize is to invite ru])ture of the mem-
brane and a conse(pient long drawn out in-
fection or extension to the mastoid, brain,
and meninges.
There is a])t to l)c a change in the whole
picture when the pneumococcus 111 is the
olfending organism. This organism is often
insidious in its attack. Pain may be only
moderate in degree and the appearance of the
ear drum is apt to be misleading.
When drainage is estal)lished free passage
must be assured by thorough swabbing timed
to keep ahead of too much accumulation of
pus.
Acute catarrhal otitis media results from
obstruction at the orifice or within the eus-
tachian tube, wherein negative pressure oc-
curs with resulting retraction of the ear
drum. A serous exudate may accumulate
within the tube and enter the middle ear.
The usual symptoms are those of a feeling
of fullness in the ear, low-grade discomfort or
pain, slight deafness and possible tinnitus.
There are usually no febrile signs or symp-
toms. The ear drum is most often found to
be retracted with the handle of the malleolus
showing very prominently. When serum is
present in the middle ear no retraction will
be seen but the drum will often show^ a low
grade hyperemia that is striated in appear-
ance. Treatment is directed to the main-
tenance of patency of the eustachian tube. If
the drum is retracted the tube may be in-
flated causing prompt cessation of symptoms.
By keeping the nasal mucosa well shrunk this
condition will usually disappear in a few
days unless there is a bad stricture or some
encroachment at the nasal orifice of the tube.
Such a condition can be determined very sat-
isfactorily by the use of the nasopharyngeo-
scope.
Host chronic purnlent otitis begins during
childhood as a sequel of acute purulent otitis
media. The reason for its chronicity is a
moot question. It may be due to persistance
of a hyperplastic mucosa, or to the develop-
ment of ]uirulent pockets and cysts in the
mucosa witli fornudation of granulation
tissue.
The signs and symptoms are those of in-
termittant or continuous aural discharge, and
some loss of hearing.
The non-dangerous type will show a cen-
tral or paracentral perforation inferiorly
and anteriorly as a rule. This area is near
the entrance to the tympanic cavity of the
eustachian tube. Here there is usually an
increase in discharge during a coryza.
The dangerous type will show perfora-
tions that are posterior and marginal. Epith-
elium is apt to grow through the perfora-
tion into the tympanic cavity causing erosion
of the bony wall and surrounding structures,
with the retention of foul pus, often under
pressure. Complications may occur heralded
by such symptoms as pain and headaches,
vertigo and fever. The possible complications
are mastoiditis, brain abscess, epidural ab-
scess, menigitis, lateral sinus thrombosis and
Continued on page 173
6ARL H. STEVENS, M. D.
President Mains Medical 'Association
19^2 - 19^3
Nineteen Hundred and Forty-two — July
161
The President's Page
To the Members of the Maine Medical Association :
The 9Uth Annual Session of the Maine Medical Association at Poland Spring
proved itself to he a very interesting and instructive session. There was a total
registration of 484, and of that number members of our Association were
present. Of the 197 guests 130 were wives of our members. The total registration
shows an increase of 2'i over that of 1941 at York Harbor. Twenty-one commer-
cial exhibitors displayed up-to-the-minute items of interest to the profession.
The Official Program, as arranged by the Scientific Committee, Currier C.
Weymouth, M. D., Farmington, Chairman, was a masterpiece of Maine Medical
programs. The members of that committee are to he congratulated upon their
accomplishment, and deserve the thanks of all officers and members for their untir-
ing efiforts in making the 90th session a complete success. The delegates from the
County Societies were present in goodly numbers and attended faithfully to their
duties : the first session of the House of Delegates meeting at 4.30 P. M. on Sun-
day. That evening the guest speaker. Rev. George W. Shepherd, of Boston, thrilled
his audience when he spoke before a large group taking for his subject, “The Battle
for Freedom in China and India.”
Monday and Tuesday mornings were devoted to five sectional conferences.
These conferences were arranged and participated in by Maine doctors and dis-
cussed by prominent out-of-state specialists. All of the conferences were well
attended, the subjects presented were timely and the discussions interesting. At the
afternoon scientific sessions on the above days, very practical and instructive papers
and lectures were delivered by prominent out-of-state specialists and teachers of
Medicine and Surgery. Members of our Association who were unable to attend
these conferences and scientific sessions certainly missed an excellent Post-Graduate
Course which was intensive and all too short.
On Monday evening Philip D. Wilson, M. D., of New York City, held the
closest attention of a large audience when he presented in a most interesting
manner his subject: “Surgical War Experiences in England.” Doctor Wilson
spoke chiefly concerning the treatment of Air-Raid Casualties and of the work of
the American Hospital in Britain, emphasizing his talk by the use of lantern slides
and motion pictures of actual scenes in England. Doctor Whlson’s presentation was
most timely and very helpful to any person who may find himself faced with the
responsibility of treating air raid casualties, and especially compound fractures.
On Tuesday evening at the Annual Banquet Walter G. Phippin, M. D., of
Salem, Massachusetts, a member of the Committee on Medical Preparedness of the
American Medical Association, and Chairman of the First Corps Area, Procure-
ment and Assignment Service, very clearly informed the members of the fact that
we are at war and of the duties we as physicians, of all ages, must perform in this
great emergency. Doctor Phippen explained in detail the medical needs of the
armed forces and informed us that if these needs are not met voluntarily then other
methods will be used to supply these needs.
So much for a brief resume of the high-lights of our 90th session. At this
time I wish to inform the members of our x^ssociation who were not at Poland
Springs that the House of Delegates adopted the recommendation of the Council
OVER
162
The Journal of the Maine Medical Association
that, because of war conditions, the Fall Clinical Session will be omitted this year.
I also call your attention to the fact that all standing and special committees have
been appointed and suggest that the members of these committees meet as early and
as frequently as practicable during the coming year. As to the next Annual Session
the time and place was left to the Council by the House of Delegates, as has been
the custom for some years.
I urge all County Secretaries to arrange for regular County Meetings as usual,
that those of us who are available, whether in or out of uniform, may have the
opportunity to get together, to confer concerning the medical home front, to secure
as much concentrated dosage of Post-Graduate teaching as possible, to stimulate
our desire to keep informed by proper reading of medical literature, and in other
ways endeavor to keep our County Societies as active and helpful to their meml)ers
as in normal times. The strength and usefulness of our State Association is de-
pendent upon good County Meetings and strong County Societies.
As to new officers in your Association, your members have elected Stephen A.
Cobh, M. D., of Sanford, as President-Elect. Doctor Cobb has served you well as a
member of your Council for three years, the last year as Chairman. He served
abroad in World War I as a Captain. Since that time he has served on many of
your important committees and was recently commissioned a Lieut. -Colonel. We
are fortunate in having such a well qualified man as Doctor Cobb as President-
Elect in these unusual times.
The Eirst District will have E. Eugene Holt, M. D., of Portland, as Councilor,
a man thoroughly familiar, not only with the Eirst District hut with the needs of
your Association.
The Second District will he well cared for by Currier C. Weymouth, M. D.,
of Earmington, who was elected Councilor for that district.
The Third District Councilor, C. Harold Jameson, M. D., of Rockland, was
re-elected to 1944 to fill the unexpired term of William Ellingwood, M. D,,
deceased.
Under the Chairmanship of Oscar E. Larson, M. D., of Machias, your Council
will work for the future interest of your Association.
Thomas A. Foster, M. D., of Portland, was re-elected Delegate to the Ameri-
can Medical Association for two years. All who heard Doctor Foster’s report of
the 1942 session at Atlantic City and those who read it, in a later issue of the
Journal, will endorse the re-election of Doctor f'oster for this important appoint-
ment.
I'rederick R. Carter, M. D., was re-elected Secretary-Treasurer of the Asso-
cialion. Doctor Carter was also elected Editor of The Journal of the Maine
Medical Association. Doctor Carter replaces Erank H. Jackson, M. D., of
I loulton, who has rendered several years of faithful and efficient service as our
editor.
The coming year will, no doubt, he a strenuous one for all members of our
profession. Whether in or out of uniform all Americans are in this war and we,
of the medical profession, must do our utmost to hasten an allied victory.
Carl H. Stevens, M. D.,
President Maine Medical Association.
P. S. Please read addresses of McNutt, Lahey, and Rankin, in the June 20,
1942, issue of The Journal of the American Medical Association.
C. H. S.
Nineteen Hundred and Forty-two — July
163
Maine Medical Association Officers Elected
at tke
90tk ANNUAL SESSION
TO LAND SPRINg
JUNE 21, 22, 23, 19^2
Stephen A. Cobb, M. D.
Sanford
'President-elect
E. Eugene Holt, M. D.
Portland
Councilor First District, 1945
Currier C. Weymouth, M. D.
Earmington
Councilor Second District, 1945
C. Harold Jameson, M. D.
Rockland
Councilor Third District, 1944
164
The Journal of the Maine Medical Association
Editorials
Medical Officers Needed Now
All of you who were present at the annual
dinner of the Maine Medical Association, on
June 23rd, and heard Dr. Walter G. Pliip-
pen, of Salem, Massachusetts, Chairman,
First Corps Area, Procurement and Assign-
ment Service, can more fully appreciate the
need for medical officers in the Army of the
United States. You can also appreciate that
now is the time to volunteer, not one month
or six months from now. You also hnow that
if a sufficient number of medical officers are
not obtained by this means, there is every in-
dication that more drastic measures will be
taken to secure them.
The response has been slow, due to some
extent to the fact that many physicians have
been under the erroneous impression that the
Procurement and Assignment Service enroll-
ment forms are equivalent to applications for
commissions, and because information con-
tained on these forms requires a considerahle
period to be tabulated and made available for
use by the recruiting personnel of the armed
forces.
Recruiting boards for medical officers have
been established in all states. The office of
the Maine Medical Officers’ Recruitina’
o
Board is located at 31 Western Avenue, Au-
gusta. These boards, working in conjunction
with the Procurement and Assignment Ser-
vice, are authorized to commission qualified
physicians in the Medical Corps of the Army,
who have been declared “available” by the
state or local officers of the Procurement and
Assignment Service. When commissioned
the physicians will be assigned to active duty
within a few weeks following application.
Ap2)lications for commissions from graduates
of unapproved and foreign medical schools
will be forwarded by the boards to the Office
of the Sur geon General for individual con-
sideration.
The Procurement and Assignment Service
is a governmental agency acting in an ad-
visory capacity to the armed forces, and de-
termining whether physicians are “available”
or “essential”; its enroll ment forms are not
applications for com missions.
Apply for your commission today, to your
Medical Officers’ Recruiting Board, and do
your part to make Maine’s response to the
call for volunteers 100%.
T he President-elect
The Association on the afternoon of June
22nd, 1942, assembled in General Session
during the 90th annual session at Poland
Spring, elected Stephen A. Cobb, M. I)., of
Sanford, President-elect. The Association is
honored in bestowing this honor upon one
who has proved himself equal to the duties
which will be his in these critical times.
Doctor Cobb was born in Gardiner, Maine,
December 9, 1887, the son of Stephen Aratas
and Hattie Chadwick Cobb. He was gradu-
ated from Gardiner High School in 1905,
Bates College in 1909, and Harvard Medical
School in 1914. He started his practice in
Sanford in 1915, and has continued there to
date with the exception of 1918 and 1919,
when he served in World War I at Camp
Jackson and Greene, and as Captain at Base
Hosj^ital 54 in France. He married Ruby
Varnuni AVood of Bowdoinham, and they
have one daughter.
He has recently been commissioned a Lieu-
tenant Colonel, and is Chief of the Surgical
Service in the 67th General Hospital, the
unit which has been sponsored by the Maine
General Hospital.
Doctor Cobb has served the Association
for seven years ; three as a member of the
Scientific Committee, one year as Chairman
of this Committee, and as Councilor foSJhe
First District for one term of three years, the
last of these as Council Chairman.
We extend to Doctor Cobb our congTatula-
tions and best wishes.
Nineteen Hundred and Forty-two — July
165
The Procurement
“On June 8, I described to the American
Medical Association at its Atlantic City meet-
ing the acute need for physicians for the mili-
tary services. I pointed out how far the
recruitment of physicians lagged behind ex-
pected quotas. In conclusion, I stated bluntly
the fact, which could not have been evaded by
any analysis, that unless voluntary recruit-
ment progressed more rapidly some more
rigorous form of selective service must be re-
sorted to.
“Those facts were necessary in order to
permit the medical profession to diagnose its
own case. And the case is urgent ; physicians
are members of what is probably the most in-
dispensable of all professions. Despite the
harshness of the facts and the bluntness with
which I had to state them, I felt that the pro-
fession should be informed.
“In fairness to the recruitment record of
many of our states, it seems in order at this
time to give the profession some further idea
of how its problem is distributed. The fail-
ure of a sufficient number of physicians to
volunteer for military service is not spread
thinly over the whole country. There is an
acute lag in certain populous states. Other
states have supplied nearly all that they
should supply.
“We need more than twenty thousand ad-
ditional physicians by the end of this year.
But eight states — Hew York, rilinois, Cali-
fornia, Pennsylvania, Massachusetts, Hew
Jersey, Michigan and Ohio — should account
for nearly sixteen thonsand of that shortage.
“By contrast, sixteen states have fewer
than a hundred physicians to go to reach the
total number they should supply. In order
not to deplete unduly available medical ser-
vice in those areas, we are asking that the
Medical Officers’ Recruiting Boards be with-
drawn and that further enlistments from
those areas be then discouraged except in the
case of the men under 37 in the urban areas.
Those states are Alabama, Arizona, Dela-
ware, Idaho, Louisiana, Mississippi, Mon-
tana, Hevada, Hew Mexico, Horth Dakota,
South Carolina, South Dakota, Utah, Ver-
mont, Wyoming and Virginia.
of Physicians"^'
“The acute problem for the next few
months for those states is an equitable distri-
bution of medical service within their bor-
ders. This will avoid the necessity for any
consideration of plans to allocate doctors
from other states to meet civilian needs.
“More than one hundred and thirty thou-
sand physicians have returned their registra-
tion forms to the Roster for Scientific and
Technical Personnel. Those forms are now
being ^^rocessed. When that work is complete
we shall be able to give the profession a more
comprehensive report on the relation of avail-
able medical service to wartime needs.
“The seriousness of the deficit in the num-
ber of physicians available for armed forces
should not be under-estimated. The need
must be met. It will be met by one method
or another. Heither must we under-estimate
the serious drain this puts on available medi-
cal services in civilian communities. It will
mean long hours and hard work — sacrifices
which will multiply the deep debt that every
community owes to its physicians.
“It cannot be met simply by multiplying
hours of the physicians who are left. There
will be a real need to exercise every possible
means for minimizing unnecessary medical
services in order that the real needs may be
met.
“It is my belief that the lag in recruitment
has been due chiefly to the fact that the indi-
vidual physician has not realized the genuine
urgency of the need. IMeasures must be taken
which will bring those home to every indi-
vidual. This means that there will have to be
some education of the general public. Pre-
ventable illness must be reduced to a mini-
mum. Unreasonable demands on the physi-
cian's time must be reduced to a minimum.
Thus only may available medical service ade-
quately cover the needs.”
An editorial in the same issue of The Jour-
nal says :
“Elsewhere in this issue appears a state-
ment bv Mr. Paul V. McHutt, chairman of
the War Manpower Commission, under
vdiich the Procurement and Assignment Ser-
vice for Physicians, Dentists and Veterina-
* Reprint of Statement for The Journal of the American Medical Associatioyi by Paul V. McNutt, Chair-
man of the War Manpower Commission, as published in the June 27th issue, and Editorial in the same issue.
166
riaiis fiiiictioiis, relative to the urgent need
for physicians for the armed forces at this
time. Mr. MclSTutt recognizes the indispen-
sable character of the physician for both mili-
tary and civilian needs. He makes clear that
eight states — Hew York, Illinois, California,
Pennsylvania, Massachusetts, Hew Jersey,
Michigan and Ohio- — must supply most of
the physicians needed for the armed forces at
this time. Some of the states have already
supplied so many physicians in proportion to
their total medical population that recruit-
ment in those states is to be discontinued now
or in the near future.
^‘The medical profession cannot be accused
of failure to play its part in any way in re-
lationship to the war effort. Everyone who
is participating in the recruitment of physi-
cians recognizes that there have been what
are now called innumerable d3ottle necks’ to
be cleared away from time to time as the
effort has progressed. More than one hun-
dred and thirty thousand physicians liave al-
ready returned the registration blanks sent
out by the Hational Roster of Scientific and
Technical Personnel. These replies have
been coded, and punch cards have been made
for them. Any physician who has failed to
receive an enrollment form from the Ha-
tional Roster should write at once to the Ha-
tional Roster of Scientific and Technical
Personnel, in care of War Manpower Com-
mission, 916 Gr Street Horthwest, Washing-
ton, D. C., requesting that an enrollment
form be sent to him.
“Shortly there will be sent to every ])hysi-
cian who indicated that service in the United
States Army Medical Department would be
his first choice or his second choice a letter as
follows :
WAR MANPOWER COMMISSION
Procurement and Assignment Service
Washington
Procurement and Assignment Service for
Physicians, Dentists and Veterinarians
Dear Doctor:
You have indicated your willingness to serve the
Nation in this great emergency. The Procurement
and Assignment Service of the War Manpower
Commission now calls on you to enter the Service.
Please apply at once for a commission. You have
been selected from among the available physicians
in your community by a process that is believed
to be fair and impartial.
The Journal of the Maine Medical Association
Complete and mail the enclosed post cards im-
mediately. The Office of the Surgeon General or
his representative will provide the necessary ap-
plication forms and authorize the time and the
place for your physical examination.
Do not take any definite action regarding your
practice until you receive specific instructions
from the War Department. Each physician who is
commissioned is routinely allowed fourteen days
to wind up his affairs after receipt of orders from
the War Department.
The rapidity of recruitment now in effect makes
tffiis communication necessary and requires your
full cooperation. Please do not delay.
Sincerely yours,
Frank H. Laiiey, M. D.,
Chairman, Directing Board,
Procurement and Assignment Service.
Enclosures
No. 92 6/22/42.
“With this letter will be enclosed two
postal cards, wliicli will secure prompt action
in relationship to the receipt of application
forms and proper notification of the action
taken in the responsible agencies in Wash-
ington.
^Mhe needs of the armed forces for physi-
cians are immediate; nnqnestionably those
needs will be met. Physicians who are under
37 years of age and who have been classified
by the Selective Service are susceptible to re-
stndy of their sitnation and reclassification as
these needs become more and more urgent.
The medical schools, hospitals, public health
departments, industrial concerns, in fact
every agency utilizing the services of physi-
cians, must cooperate hy restndying the men
classified as essential, so that only those who
are actually essential in the most restricted
sense of that word will be retained. All
others must be made available as needed for
the service of the nation in the armed forces.
“The Procurement and Assignment Service
for Physicians, Dentists and Veterinarians
was established to aid in the proper assign-
ment of j^hysicians in times like these to the
tasks for which they are best fitted. Already
this agency has been of immense value in the
principles tliat have l)een adopted relative to
the maintenance of medical education, hos-
pital service and civilian health, as well as
the study and evaluation of men for the
Army and Havy medical departments. As
the needs become more acute and the num-
ber of men available less, their task assumes
increasing importance. The War Manpower
Commission is now the agency under which
Continued on page 173
Nineteen Hundred and Forty-two — July
167
HERBERT E. L06KE, Atiovney
Herbert E. Locke, Attorney, of Augusta, legal counsel for the Maine Medical
Association for many years, was elected an honorary member of the Association at
the First Meeting of the House of Delegates in session June ai, 1942, during the
90th Annual Session, at Poland Spring. Thus Mr. Locke becomes the Association’s
first non-medical honorary member; an honor well deserved.
168
Nominating Committee Report
The report of the h^omiiiating Committee as presented and accepted
at the Second Meeting of the House of Delegates at the 90th Annual Ses-
sion of the Maine Medical Association at Poland Spring, Maine, June 22,
1942.
N ominating C ommittee
C. Harold Jameson, M. D., Rockland, Chairman.
Frank A. Smith, M. D., Westbrook.
Merrill S. F. Greene, M. D., Lewiston.
Raymond L. Torrey, M. D., Searsport.
Raymond E. Weymouth, M. D., Bar Harbor.
Harvey C. Bundy, M. D., Milo.
The Journal of the Maine Medical Association
Standing Committees
Scientific C ommittee
Eugene E. O’Donnell, M. D., Portland,
Chairman.
Forrest B. Ames, M. D., Bangor.
Roland L. McKay, M. D., Augusta.
Harvey C. Bundy, M. D., Milo.
C ommittee on Medical Education and
Hospitals
Adam P. Leighton, M. D., Portland,
Chairman.
Allan Craig, M. D., Bangor.
Medical Advisory C ommittee
Carl M. Robinson, M. D., Portland, Chair-
man.
Allan Woodcock, M. D., Bangor.
Stephen A. Cobb, M. D., Sanford.
Willard H. Bunker, M. D., Calais.
C. Harold Jameson, M. D., Rockland.
Frank H. Jackson, M. D., Hoiilton.
Forrest B. Ames, M. D., Bangor.
The Secretary, ex-ofScio.
Legislative C ommittee
The President, ex-othcio.
The President-elect, ex-officio.
Frederick R. Carter, M. D., Augusta,
Chairman.
Public Relations C ommittee
R. V. 1ST. Bliss, M. D., Bluehill, Chairman.
Frederick T. Hill, M. D., Waterville.
Henry C. Knowlton, M. D., Bangor.
Harold E. Small, M. D., Eort Eairfield.
Edward M. Cook, M. D., York Harbor.
Cancer C ommittee
Mortimer Warren, M. D., Portland, Chair-
man (One year).
Magnus Ridlon, M. D., Bangor (Two
years).
William Holt, M. D., Portland (Three
years).
Arthur H. McQnillan, M. D., Waterville.
(Eonr years).
Julius Gottlieb, M. D., Lewiston (Five
years).
C ommittee on Social Hygiene
Richard P. Jones, M. D., Belfast, Chair-
man.
Carl E. Blaisdell, M. D., Bangor.
Oscar R. Johnson, M. D., Portland.
Publicity C ommittee
Frederick R. Carter, M. D., Augusta,
Chairman.
Carl H. Stevens, M. D., Belfast.
Financial Advisory Committee
George L. Pratt, M. D., Farmington,
Chairman (1944).
Warren E. Kershner, M. D., Bath (1943).
Foster C. Small, M. D., Belfast (1945).
Delegate to the American Medical Associ-
ation for Two Years (1943-1944)
Thomas A. Foster, M. D., Portland.
169
Nineteen Hundred and Forty-two — July
Special Committees
As appointed by the President, Carl H. Stevens, M. D., Belfast, in
accordance with the By-Laws, Chapter Section 1.
C ommittee on Graduate Education
Frederick T. Hill, 1\[. I)., Waterville,
Chairman.
Julius Gottlieb, M. D ., Lewiston.
E. Eugene Holt, i\E. I)., Portland.
Frank H. Jackson, M. D., Houlton.
LeRoy H. Smith, i\r. L)., Winterport.
James Carswell, IM. 1)., Camden.
Thomas A. Foster, i\I. 1)., Portland.
Tiiherculosis C ommittee
Edward A. Greco, i\I. 1)., Portland, Chair-
man.
Loren F. Carter, i\[. 1)., Presque Isle.
Charles 1). Cromwell, M. 1)., Fairfield.
Lester A. Adams, i\L ])., Hebron.
Georg'e E. Young, M. 1)., Skowhegan.
James W. Laughlin, M. 1)., Newcastle.
Norman E. Cobb, l\r. 1)., Calais.
Francis J. Welch, M. I)., Portland.
C ommittee on Maternal and Child Welfare
Albert W. Fellows, M. 1)., Bangor, Chair-
man.
Clair S. Bauman, M. D., Waterville.
LeRoy C. Gross, M. D., Auburn.
Alice S. Whittier, M. D., Portland.
Virginia C. Hamilton, M. D., Bath.
Guy E. Dore, M. 1)., Guilford.
Thomas A. Foster, M. D., Portland.
C ommittee to Survey Hospital and
Medical Care
S. Judd Beach, M. 13., Portland, Chair-
man.
J. Calvin Oram, M. D., South Portland,
Secretary.
Edward M. Cook, kl. D., Amrk Harbor
(Eirst District).
George L. Pratt, M. D., Earmington (Sec-
ond District).
Warren E. Kershner, M. D., Bath (Third
District).
Edward H. Risley, M. D., Waterville
(Fourth District).
Willard H. Bunker, M. D., Calais (Fifth
District).
Storer W. Boone, M. D., Caribou (Sixth
District).
Roscoe L. Mitchell, M. D., Augusta (De-
partment of Health and Welfare).
C ommittee to Investigate Collection
Agencies
Adam P. Leighton, 1\L D., Portland.
C ommittee on Industrial Health
Joseph B. Drummond, IH. D., Portland,
Chairman.
Edwin M. Fuller, M. D., Bath.
Eugene M. IMcCarty, ]\f. D., Rumford.
Arthur H. McQuillan, M. D., Waterville
Allan Woodcock, M. D., Bangor.
Roscoe L. Mitchell, M. D., Augusta.
C ommittee for C onservation of Vision
Warren E. Kershner, M. D., Bath, Chair-
man.
Howard E. Hill, M. D., Waterville.
S. Judd Beach, M. D., Portland.
William R. McAdams, M. D., Portland.
E. Eugene Holt, M. D., Portland.
Amy W. Pinkham Fund C ommittee^
Thomas A. Foster, M. D., Portland, Chair-
man.
Virginia C. Hamilton, M. D., Bath.
Guy E. Dore, M. D., Guilford.
Albert M. Garde, M. D., Milo.
Oscar E. Larson, M. D., Machias.
Clair S. Baiunan, M. D., Waterville.
P. L. B. Ebbett, M. D., Houlton.
* As appointed by the Council at a meeting held
June 23, 1942, at the Poland Spring House, and
approved hy the President, Carl H. Stevens, M. D.
170
The Journal of the Maine Medical Association
Necrologies
William Delue Anderson, M. D.
1881-1942
William Delue Anderson, M. D„ aged 61, died
suddenly at his home in South Portland, on Sun-
day, March 1, 1942.
Doctor Anderson was born on February 20, 1881,
the son of John W. and Helen E. Anderson of
Portland, Maine. He attended the schools of Port-
land and graduated from the Portland High School.
He then entered the Drug Business, which he fol-
lowed very successfuly for a few years. In 1911 he
decided to enter Bowdoin Medical School, and after
his graduation in 1915, he was appointed an intern
at the Maine General Hospital. Leaving the Maine
General Hospital in 1916, he bagan the practice of
his chosen profession in Portland, being, up to the
time of his death, a conscientious and beloved
physician and surgeon.
Doctor Anderson was an instructor in anatomy
at the Bowdoin Medical School for several years,
and served as house physician at St. Luke’s Hos-
pital in New York, also having taken post-graduate
work at the same hospital. He served as medical
examiner of Cumberland County from 1922-1926.
Doctor Anderson was an active member of his
Medical Societies, both local and national, being a
member of the Association for the Study of Goitre,
a Fellow of the American College of Surgeons, and
also of the American Medical Association.
Doctor Anderson was a very active and faithful
member in the Masonic Bodies. He was a 32nd
Degree Mason and a member of the Shrine. He
will be greatly missed by these Brother Masons,
as well as by his brother practitioners.
Doctor Anderson is survived by his widow, the
former Leo Elliott of Portland, and a brother,
George, of Manchester, New Hampshire.
The Members of this Medical Society feel deeply
the loss of its member. Doctor William D.
Anderson.
George A. Tibbetts, M. D.
IssAC M. Webber, M. D.
Philip P. Thompson, M. D.
Herbert A. Owen, M. D.
1871-1942
Herbert A. Owen, M. D., aged 71, widely known
physician, died at his home in Buxton, on Sunday,
June 7, 1942, of heart disease, with which he had
suffered for some time.
Doctor Owen was horn at Buxton, Maine, on
March 10, 1871, the son of Mark and Matilda Har-
mon Owen. He was graduated from Bowdoin Col-
lege in 1893, and from Rush Medical College in
1898. He practiced in Chicago, Illinois, and Pen-
togo, Michigan, until thirty-three years ago, when
he returned to Buxton.
He was a member of the York County Medical
Society, the Maine Medical Association, and the
American Medical Association, and of the First
Parish Congregational Church, Buxton Lower Cor-
ner, and the West Buxton Lodge of Masons.
Doctor Owen is survived by his widow, the for-
mer Isadore Macurda of Wiscasset, a stepdaughter,
Mrs. Isabel Conant of Gorham, and three sisters,
Mrs. Venetta Sanborn of Portland, Mrs. Anna
Sampson of Gorham, and Mrs. Ellen Hadlock of
Whitman, Massachusetts.
171
Nineteen Hundred and Forty-two — July
COUNTY SOCIETIES
Androscoggin
President, Camp C. Thomas, M. D., Lewiston
Secretary, Charles W. Steele, M. D., Lewiston
Aroostook
President, Harold E. Small, M. D., Fort Fairfield
Secretary, Gerald H. Donahue, M. D., Presque Isle
Cumberland
President, Roland B. Moore, M. D., Portland
Secretary, Eugene E. O’Donnell, M. D., Portland
Frank! in
President, James W. Reed, M. D., Farmington
Secretary, George L. Pratt, M. D., Farmington
Hancock
President, Ralph W. Wakefield, M. D., Bar Harbor
Secretary, M. A. Torrey, M. D., Ellsworth
Kennebec
President, L. Armand Guite, M. D., Waterville
Secretary, Frederick R. Carter, M. D., Augusta
Knox
President, James Carswell, M. D., Camden
Secretary, A. J. Fuller, M. D., Pemaquid
Li nco In-Sagadahoc
President, Edwin M. Fuller, Jr., M. D., Bath
Secretary, Jacob Smith, M. D., Bath
Oxford
President, Albert P. Royal, M. D., Rumford
Secretary, J. S. Sturtevant, M. D., Dixfield
Penobscot
President, Albert W. Fellows, M. D., Bangor
Secretary, Forrest B. Ames, M. D., Bangor
Piscataquis
President, Fred J. Pritham, M. D.,
Greenville Junction
Secretary, Norman H. Nickerson, M. D., Greenville
Somerset
President, Allan J. Stinchfield, M. D., Skowhegan
Secretary, M. E. Lord, M. D., Skowhegan
Waldo
President, Lester R. Nesbitt, M. D., Bucksport
Secretary, R. L. Torrey, M. D., Searsport
Washington
President, Perley J. Mundie, M. D., Calais
Secretary, James C. Bates, M. D., Eastport
York
President, Carl E. Richards, M. D., Alfred
Secretary, C. W. Kinghorn, M. D., Kittery
County News and Notes
Cumberland
The 165th meeting of the Cumberland County
Medical Society was held at the Eastland Hotel,
Portland, Maine, on Friday, May 29, 1942.
The meeting was called to order by Roland B.
Moore, M. D., President.
Admitted to membership were: Daniel Lovelace,
M. D., Gorham; James B. Morrison, M. D., West-
brook; and Lawrence W. Conneen, M. D., Portland.
Resolutions on the deaths of William D. Ander-
son, M. D., and Charles B. Sylvester, M. D., were
adopted by the Society.
The speaker of the evening was Paul Dudley
White, M. D., of Boston, whose subject was Status
of Heart Disease in 19J,2. Doctor IVhite’s paper
was discussed by Drs. Elton R. Blaisdell, Ralf
Martin, and Langdon T. Thaxter.
The meeting was preceded by a clinic at the
Maine General Hospital at 5.00 P. M., at which
the following papers were presented:
1. Diplipliei'oUl Vulvo Vaginitis, Leon Babalian,
M. D.
2. Cancer of the Bectxini, Eaton S. Lothrop, M. D.
3. Paroxysmal Ventricular Tachycardia, Elton
R. Blaisdell, M. D.
4. Gastrostomy, Carl M. Robinson, M. D.
5. Four Fractured Knees, Orthopedic Service.
6. Bilateral Kidney Disease, Urological Service.
Eugexe E. O’Doxxell, M. D.,
Secretary.
Oxford
A regular meeting of the Oxford County Medical
Society was held at Bethel Inn, Bethel, Maine,
Wednesday, June 3, 1942.
At the business meeting P. L. B. Ebbett, M. D.,
of Houlton, Maine, President of the Maine Medical
Association, gave a general talk on Association
affairs. Wedg\vood P. Webber, Capt., M. C., gave an
interesting talk on the Army and Navy.
George Geyerhahn, M. D., of Lovell, was elected
to membership.
Following the dinner, Elton R. Blaisdell, M. D.,
and Langdon T. Thaxter, M. D., of Portland, pre-
sented an interesting and instructive talk on the
subject. Low Suhsternal and High Eyigastric Pam.
Prohlems in Diagnosis.
J. S. Stuktevant, M. D.,
Secretary.
Piscataquis
A meeting of the Piscataquis County Medical
Association was held at the Mayo Memorial Hos-
pital, Dover-Foxcroft, Maine, May 21, 1942.
It was unanimously voted that R. H. Marsh,
M. D., of Guilford, be recommended for the Fifty-
Year Medal and Honorary Membership in the
Maine Medical Association.
It was voted that we again have a special sum-
mer meeting at Moosehead Lake, and that we
invite Aroostook, Penobscot, Somerset, Kennebec,
Hancock, and Waldo Counties to meet with us.
172
Our guest speaker was Brig. Gen. John G.
Towne, M. C., of Waterville, State Chairman of the
Procurement and Assignment Service of Maine.
General Towne gave us a most instructive talk
regarding the Procurement and Assignment Serv-
ice. Many personal questions were asked and
answered. I believe that, having heard General
Towne, there is no question but that the members
of the Piscataquis County Medical Society will do
their duty by their Country. The next Councilor’s
report will probably show a fair percentage of the
membership of the County Society in the service.
Thirteen members were present. One of our
members is already in the service. Thus there
were present 13 of a possible 17. A little better
than 79% attendance.
Respectfully submitted,
N. H. Nickerson, M. D.,
Secretary.
Members in Military Service
Members Sworn Into United States Army
by First Lieut. Richard Maxant,
U. S. A., at the 90th Annual
Session at Poland Spring
Captain Frank B. Bull, Gardiner, Maine
(Kennebec County Medical Association)
Captain Harry M. Wilson, Bethel, Maine
(Oxford County Medical Society)
Captain Clarence Emery, Jr., Bangor, Maine
(Penobscot County Medical Association)
First Lieutenant John B. Curtis, Milo, Maine
(Piscataquis County Medical Society)
Captain Paul S. Hill, Jr., Saco, Maine
(York County Medical Society)
New Members
Cumberland
Lawrence W . Conneen, M. D., 131 State Street,
Portland, Maine.
Daniel Lovelace, M.D., Gorham, Maine. (By
transfer from the Connecticut State Medical
Society.
James B. Morrison, M. D., 582 Main Street, West-
brook, Maine.
Oxford County
George Geyerhalin, M. D., Lovell, Maine.
The Journal of the Maine Medical Association
Change of Address
Donald H. Daniels, M. D.
Prom: 5 Bramhall Street, Portland, Maine
To: 974 Sawyer Street, South Portland, Maine
Clement P. Wescott, M. D.
From: 1600 Forest Avenue, Portland, Maine
To: 201 State Street, Portland, Maine
Notice
Decontamination of Eyes After Exposure
to Lewisite and Mustard
Since publication of the Office of Civilian De-
fense handbooks, “First Aid in the Prevention and
Treatment of Chemical Casualties” and “Protec-
tion Against Gas,” further experience has shown
that the 2% solution of hydrogen peroxide recom-
mended for the treatment of eyes following
Lewisite burns may be injurious if used undiluted.
The Chemical Warfare Service now recommends a
single instillation in the eyes of a 0.5% solution of
hydrogen peroxide as soon as possible after con-
tamination with Lewisite. This solution may be
prepared by diluting one part of a 2% solution
with three parts of water, or one part of a 3%
solution with five parts of water. The solution
usually found in drugstores is the U. S. P. strength
of 2,5 to 3.5 per cent hydrogen peroxide. A 0.5%
solution of potassium permanganate has also been
found effective as an eye instillation following
exposure to Lewisite.
In planning decontamination stations, the Medi-
cal Division, Office of Civilian Defense, recom-
mends that provision be made near the entrance
of the second or shower room for the irrigation of
the eyes of contaminated persons. The schematic
sketch of a decontamination station in the Office
of Civilian Defense publications mentioned above
shows the irrigation of eyes in the dressing room,
whereas this should be carried out in the second
or shower room before the bath is given. Delay
until the casualty reaches the dressing room will
result in more serious injury to eyes which have
been contaminated with mustard or Lewisite.
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Nineteen Hundred and Forty-two — July
173
Rhinology and Otology— Continued from page 159
acute labyrintliitis. It is always a potentially
dangerous disease so that in the event of any
suspicion of complications a modified radical
mastoidectomy should be performed.
In chronic catarrhal otitis media the pa-
tient complains of long standing diminution
in hearing and tinnitis, with relapses and re-
missions. Head colds often intensify the con-
dition. Deafness usually does not become
total.
The drum is seen to be retracted and dull.
Repeated inflation of the eustachian tube may
help some. For the tinnitis, intramuscular
injection of prostigmine as is usually prac-
ticed, is of very doubtful value.
The most frequent cause of deafness and
tinnitis is otosclerosis. Here we will usually
obtain a family history of deafness. The ear
drum will most often appear normal. Total
deafness may result. Repeated pregnancies
intensify this type of deafness. ISTo treatment
is satisfactory. Lip reading education should
be advised early. Hearing aids are of value.
Finally, it is important to remember the
normal funcation of the mucous membrane
of the nose and to direct nasal medication
accordingly. Successful treatment of diseases
of the nose, paranasal sinuses and the ears
depends on a basic knowledge of the anatomy
and physiology of these parts couj3led always
with the employment of simple common sense
medical and surgical principles.
Procurement of Physicians-Continued from page 166
the Procurement and xlssigiiment Service
functions. Through the activities of various
subcommittees such problems as maintenance
of essential staff members for hospitals, the
determination of adequate medical service
for the civilian population needs, of adequate
personnel for urban, county, state and na-
tional health departments and the needs of
industry are being given special considera-
tion. The medical profession, as Mr. MclSTutt
has repeatedly emphasized, has in these ac-
tivities shown the way to scientific study and
allocation of manpower in this emergency.’’
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Camel Cigarettes VIII
Children’s Hospital, The XI
Coca-Cola V
Corn Products Sales Company XII
Frye Company, Geo. C 173
Gay Private Hospital XIII
Hospital Pharmacy, Inc 173
Hynson, Westcott & Dunning, Inc XII
Jones’ Private Sanitarium XIII
Leighton’s Hospital, Dr XIII
Lilly & Company, Eli X
Marks Printing House XI
Mead Johnson & Company XV
Medical Auditing Counsel XI
Parke, Davis & Company Ill
Petrogalar II
Philip Morris & Co VI
Physicians Casualty Association ...... XII
Prentiss Loring, Son & Co 173
Rich, S. S XI
S. M. A. Corporation IX
State Street Hospital XIII
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The Journal
of the
Maine Medical Association
Uolume Thirti^^three Portland, Ulaine, August, 1942 No, 8
An Old-Fashioned Medical School
Presented By
Waltee E. Tobie, ]\r. I).
Thursday, October 16, 1941
Cumberland County Medical Society
The seveiity-seveiith course of the ^fedical
School of ]\Iaiiie at Bowdoin College, as it
was then titled, coniinenced on January T,
1897, and continued twenty-four weeks, end-
ing June 25. Three such courses were re-
quired for graduation, hut students were ex-
pected to have studied for three full years,
generally with a preceptor, or at the Portland
School for Medical Instruction in the sum-
mer, which answered this particular require-
ment. The original plan of study with a pre-
ceptor was undoubtedly of consideralJe value.
In the case of a student in the country, he
registered with a physician, read his books,
accompanied him somewhat on his calls, and
rendered assistance al)ont his house and office,
which assistance I think occasionally in-
cluded some care of the doctor’s horses an<l
carriages.
I tliink the specilic re<piirements of this
preceptor feature had slip]>ed somewhat l)y
1897 and had become in many cases a per-
functory atfair. A practicing ])hysician
would be accomodating enough to permit a
prospect iA'c student to register with him with-
out demanding any particular attendance,
and without checking the amount of study
that he did, and sometimes even dated the
beginning of his apprenticeship back in order
to make out the three full years at the time
of graduation. The catalog of that year and
a number of snl)se(pient years contained a list
of students and preceptors, and there was fre-
quent mention of the P. S. M. I., meaning,
Portland School for Medical Instruction.
The technical requirements for matricnla-
ticm were nominal, but on the whole adequate.
good English education including compo-
sition, natural philosophj^ and mathematics
was required, but not Chemistry and Latin.
Those who were graduates of high schools,
normal schools and colleges, and those who
liad passed the entrance examinations into a
college, were admitted on presentation of
their diplomas or certiticates. All others were
required to pass an entrance examination
which was held in the forenoon on Thursday,
J annary 7. The examination was a fair one.
176
A very considerable proportion of the stu-
dents of that year qualified in this manner,
and these men, for the most part made good,
for they had prepared themselves by careful
study and showed u]j in their classes and at
graduation as well as those possessing di-
plomas from high schools, seminaries and
colleges. About a third of the class of that
year qualified in this manner and of the
group taking the examination, onlj^ one was
thrown out.
As regards the students who entered by
diploma, the recpiirements were exacting —
in the catalog. They were supposed to pre-
sent their diplomas at the time of matricula-
tion, and probably did. The Dean of the
school was Dr. Alfred Mitchell, Sr., of de-
lightful memory, and he was wont to dele-
gate the function of admission to his secre-
tary, a most kindly old man named Metcalf,
who on the entrance morning sat in a room
on the second floor of Seth Adams Hall, re-
ceived the di])lomas and entered the names.
The diplomas were brought in in round tin
cylinders and I witnessed the function of
registration with great awe. Undoubtedly the
cylinders or boxes contained the diplomas,
although I did not observe that dear ohl
Metcalf ever opened a box to verify its con-
tents.
By earl}^ afternoon the details of student
admission had been completed, the examina-
tion papers had been carefully marked, the
credentials carefully inspected, and an intro-
ductory lecture was to be delivered at three
o’clock, as the catalog said, by Prof. Charles
O. Hunt, M. D. This exercise was held in
Memorial Hall and at this time of year the
sun set early, and possibly there was some
slight delay in starting, for I recall that Me-
morial Hall was rather inadequately lighted.
It was not completely equipped with elec-
tricity. I think there were a number of six-
teen-watt incandescent lamps around the
walls, but the reader’s desk had no such pro-
vision, so it was found necessary to install,
temporarily, additional illnmination. This
consisted of a rather tall kerosene lamp of the
pedestal variety which was brought in by the
teacher of Greek of the college. Professor
Woodruff. The professor had long been
known by the sobriquet of “Whiskers”; not
The Journal of the Maine Medical Association
an offensive epithet at all but a term of en-
dearment applied by the “Bits”, and a truly
descriptive title. The audience had assem-
Ijled when Professor Woodruff marched down
the center aisle with becoming dignity, bear-
ing aloft this kerosene lamp, but when he
reached the reader’s desk he encountered me-
chanical difficulties, for it was made with a
marked slant and so he endeavored to level
the lamp with a few adjacent textbooks. He
was cheered by the assembled “Pits” but I
am sorry to say that being only a Professor
of Greek and not a master mechanic, his
efforts were not crowned with success and an-
other sterling character was called in in the
person of Isaiah Simpson, also bewhiskered,
who was superintendent of buildings and col-
lege carpenter. He gave this beacon a stable,
level foundation, and Dr. Charles O. Hunt
delivered his splendid, plain, practical talk,
after which the students dispersed and Dr.
Hunt returned to Portland.
The fees were seventy-eight dollars eacli
for first and second courses, and fifty dollars
for the third course, with a matriculation fee
of five dollars and the gTaduation fee, includ-
ing the diploma, was twenty-five dollars, so
tliat the entire amount the school received
from each student was two hundred and
thirty-six dollars, plus small charges for ma-
terials used in the chemical laboratory and
the actual cost of the dissecting material,
which was not large.
Most of the students were in moderate cir-
cumstances, but some were very poor, and
quite a good many had borrowed money to
pay for tbeir education. I made inquiries
from an upper classman before I entered as
to the anionnt of money required. He told me
that a man should have for the three school
years, with living expenses included, about
fifteen hundred dollars, although some men
got through on twelve hundred. I think, as
a matter of fact, I paid about nineteen hun-
dred, but I lived in a lavish manner, paying-
two dollars a week for my room and three
dollars and twenty-five cents or three dollars
and fifty cents a week for board. This
amount also included two terms at the Port-
land School for Medical Instruction held at
vacation time in Portland.
The manner in which students lived was
Nineteen Hundred and Forty-two — August
177
quite interestiug. The residents of Bruns-
wick had long been accustomed to rent rooms
to medical students and the usual price was
two dollars a week per man for one student
or two in a room. i\Eost of the men had room-
mates. I tried it the first year hut the second
and third years roomed alone, still paying the
two dollars. The apparent inconsistency in
these rates is not explained. In those days
twin beds were non-existent and the house-
keeper could make up the double bed for two
men about as easily as for one. We furnished
our own kerosene for the lamps by which we
studied, and bought our own wood or coal for
the stove that heated the room.
For a time there were so-called eating
clubs. Such a club would he made up of a
number of students, ten, fifteen or perhaps
twenty, who paid the expenses, pro-rated by
a student steward who got his own board free.
The lowest priced club was the Gutter Club
and the charge was one dollar and seventy-five
cents a week for twenty-one meals. It was
possible for one to live at this rate ; appar-
ently some did, hut I tried it for a while and
then gracefully retired. I was not an epicure
but really wanted something a little better
than the kind and amount that was furnished
at this bargain price of one dollar and sev-
enty-five cents a week. I never knew what
became of the steward of the ISTutter Club
after gTaduation. He should have become a
hospital steward. What a hit he would have
made (with the management).
It may be asked how the entrance require-
ments of our school compared with those of
others, and I think we can fairly claim that
on the whole they were as high as any, with
a few notable exceptions. There were schools
having requirements rather higher than ours,
as cataloged, hut I happen to know that some
of them actually hid for students, offering to
take them in under conditions, and such con-
ditions were easily worked off or even for-
gotten if the classes were not too large and
the student happened to be a fair prospect.
On the other hand, there were a number of
schools whose entrance requirements were
lower than ours and our Dean, Dr. Alfred
Mitchell, was disj^osed to refer to some of the
rather low gvade schools in southern cities as
Botany Bay Institutions. He named them
thus in a spirit of jocosity, for harshness and
unfairness was foreign to his nature.
Most of the school exercises were held in
Seth Adams Hall near the apex of the delta.
The building was not new and the lecture
rooms were of a Gothic character. The one
on the second floor was devoted to physiology,
materia medica and the practice of medicine,
and the one on the third floor was the par-
ticular, peculiar property of the departments
of sui’O’erv and anatomv. These rooms were
both constructed on the old-fashioned. amphi-
theater plan, the upper room having a very
steep tier of seats, so that students in the
back rows looked down upon the lecturer.
In the pit of the surgical amphitheater was
a revolving pedestal operating and demon-
stration table. This was a treasured relic ; a
memento of the justly famed surgical pro-
fessor, William Warren Greene, who used it
in his operative clinic and probably per-
formed there some of the first thyroidec-
tomies ever performed in the world. This
table received vearlv a coat of thick red lead
paint, and the accumulated amount was so
great that one could only estimate its original
thickness. A life-size picture of William
Warren Greene, beautifullv executed bv the
old photographic and crayon process, adorned
the wall, and this was the only attempt at
ornamentation in the room. The room below
had a similar portrait of a former professor
of medicine. Dr. Eobinson.
The rooms were in charge of an elderly
man named Adam Booker, and every morn-
ing in the winter time l\Ir. Booker warmed
them up by means of very large wood stoves,
into which he fed great chunks of rock maple.
This method of heating was adequate and
more than adequate for the day, although it
did not last over. There was no water system
on the third floor, so no danger of freezing
at night.
Mr. Booker rang a large hand bell at the
beginning and closing of each hour, and kept
the rooms as clean as he could. Smoking was
not ]3ermitted, but the chewing of plug to-
bacco — Horse Shoe and B. L. Double Thick
— was not uncommon, and since there were
no spitoons the floor was not always immacu-
late. Fortunately, however, the rude char-
acters who resorted to this form of solace and
178
comfort usually occupied the same seats, and
after a few sessions they could locate theii“
seats without difficulty, and by the same
token these seats could be avoided by those
not addicted to this repreheiisihle practice.
Most of the professors, lecturers and dem-
onstraters lived in Portland and came in on
the early Maine Central train which left that
city at seven and reached Brunswick a little
before eight, enabling them to reach the
school building by eight and start their exer-
cises by eight-fifteen. The distance from the
Maine Central Station to Seth Adams Hall
was not great and most of the professors
walked up, although I)r. Israel T. Dana who
was advanced in years, and Dr. Stephen H.
Weeks who was no longer young, rode either
in the two-horse carriage of Emery Crawford
at twenty-five cents a haul, or the one-horse
carriage of Charles Stone for ten cents.
Dr. I. T. Dana, who gave the course in
Medicine, was seventy years old at the time,
and looked it. He had begun to show slight
symptoms of mental deterioration and it was
understood that 1897 was to be his last year.
He was a very splendid teacher and practi-
tioner of medicine and had had a very fin-
ished medical education, including studies in
Europe. He was a little deaf, a most unfor-
tunate defect in a teacher, but he maintained
throughout this year the suave, polished man-
ner that had always characterized him and
gave a perfectly splendid course for those
who saw fit to avail themselves of his teach-
ing. I am a little fearful that a few slid
through without as much application to his
instruction as it really merited, but this did
not concern tlie entering class for we were
not obliged to take this course and did not,
although we occasionally went in to listen to
his lectures.
Dr. Alfred Mitchell this year was Pro-
fessor of Obstetrics and Diseases of Ohildren,
and was a most delightful, entertaining and
instructive teacher.
Dr. Stephen H. Weeks was a splendid lec-
turer and teacher of Surgery of the old
school. He covered the entire course includ-
ing most of the branches now rated as spe-
cialties, and gave an operative clinic every
Saturday morning. It was a remarkable
affair in more ways than one.
The Journal of the Maine Medical Association
Dr. Erederic Henry Gerrish was certainly
the greatest teacher that I ever knew, and as
a lecturer and classroom instructor on anat-
omy had, I believe, no equal in the country.
Dr. John F. Thompson taught Diseases of
Women.
Dr. Franklin C. Robinson taught Chemis-
try in the Searles’ Building on the campus,
a new and well-equipped building at that
time. He took men with no knowledge of
chemistry, and many times with no aptitude
for it, and in his course covering two years
turned them out with all the knowledge of
chemistry they needed to practice medicine.
He was exceedingly popular and a most de-
lightful man.
Dr. Charles 0. Hunt taught Materia Med-
ica and Therapeutics in a plain, practical,
systematic manner. His course was complete
and satisfied the most exacting.
Dr. Charles D. Smith gave lectures and
instruction in Physiology. His course was
not elaborate and might not be rated as com-
plete at the present time, but I believe he
gave enough, all that was needed, and for
many, more tlian was wanted.
Dr. Addison S. Thayer, who later became
Professor of Medicine and Dean of the
School, was at this time serving in a very
minor capacity. He was Assistant to the
Chair of Pathology and Practice and I do
not remember that he appeared at all during
our first school year.
Dr. William Lawrence Dana was Demon-
strator of Anatomy and Histology. He gave
a quiz in Osteology the first part of the
school year and died suddenly just as he was
inaugurating the dissecting term. His place
was taken by Dr. Alfred King.
Dr. Willis Bryant Moulton gave Clinical
Instruction in Diseases of the Eye and Ear.
Two men came from away and gave short
courses; Hon. Lucilius Alonzo Emery in
Medical Jurisprudence and Dr. Albert Ros-
coe Moulton in Mental Diseases.
In 1898 changes in the school were as fol-
lows : Dr. Alfred Mitchell became Professor
of Medicine, Dr. Charles Augustus Ring be-
came Lecturer in Obstetrics, Addison San-
ford Thayer had Diseases of Children, Henry
Herbert Brock became Assistant to the Chair
of Surgery, and Frank Kathaniel Whittier
Nineteen Hundred and Forty-two-— August
179
became Instructor in Bacteriology and Patho-
logical Histology, a remarkable addition to
the faculty in every way. Edward -Tames
HcDonongli became Demonstrator of His-
tology; and the entrance requirements were
changed to include a knowledge of Latin and
Elements of Chemistry.
The dissecting room, which in 1897 had
been a little crude and not altoo’ether satis-
factory on account of the difficulty of secur-
ing material, showed a marked improvement.
A new anatomical law gave adequate dissect-
ing material, and Dr. Alfred King improved
the character of this branch in every way.
The entering class of 1898 was large as it
was intimated that the school was to become
a four-year school in a short time.
The entering class of 1897 was reduced in
numbers quite perceptibly, but it was still
large. We had in our entering class several
hold-overs, men who had been first-year stu-
dents for one, two and even three years and
had not made their grades. There were also
a few who had been sent there apparently be-
cause their parents had no other means of
disposing of them, and they Avere not missed
Avhen they left or were left.
At the end of its third year our class,
originally seventy-five, graduated thirty-nine.
Idiey had dropped out all along the line. A
few gave it up in discouragement, one or tAvo
for lack of money, and a number transferred
to other schools. This shifting about Avas not
uncommon. Dartmouth ]\redical School at
that time conducted a summer session and a
smart student aaIio Avas desirous of getting
into practice quickly could spend a Avinter
session at lloAA^doin, a summer session at
Dartmouth, and return in the Avinter to Boav-
doin, qualifying as a third-year student in-
stead of a second if he Avere able to pass the
examinations, but this he must do. There
Avas never any letting ujj of examination re-
quirements in any of the three years. What-
ever a man’s knoAvledge may liaA^e been Avhen
he entered, he could not graduate unless he
passed eA^ry branch of the three years Avith
a rank of at least seventy in each.
Anatomy, ])hysiology and chemistry Avere
passed off in the first and second years, and
the third year Avas deA^oted to the practical
branches. There Avas a large amount of study-
ing to do but, generally si)eaking, not the fear
that ins])ired the first- and second-year stu-
dents, for it Avas (piite generally believed that
a man Avould not be plucked in his third-year
studies. Unfortunately, some of those Avho
cherished this comfortable assurance met
Avith disa])])ointment and failed to make the
grade, ami on the Avhole, nothing but appli-
cation and untiring industry for the full
three years inade graduation an assured fact.
I do not hesitate to state that those Avho
graduated in 1899 had received a complete
medical education, as medical education Avas
understood at that time. Many of these men
had received as many honrs of instruction as
though they had attended a four-year school,
and 1 refer to those A\dio Avere students of
the Portland School for iMedical Instruction
in the summer. This school, at that time,
was housed in a building on Middle Street
over the Canal Bank, Avith a dissecting room
on the top fioor. It conferred no degrees, but
made the Avork in the Medical School of
Maine mnch easier. It also gave its students
clinics and bedside instruction at the ]\Iaine
General Hosj)ital, something Avhich Avas lack-
ing for those avIio took the courses at Bruns-
AAuck only. The Alaine Aledical School did
ii(g afford a chance for research Avork and
did not give extensive courses in the special-
ties, although as a matter of fact a nnmber*
of its graduates Aveiit into the specialties
after very short post-graduate courses in the
large cities, attained proniiiience if not emi-
nence, and quite respectable financial re-
Avards.
Without being too complacent, I think AA^e
may state that our medical graduates of that
time did just as AA^ell in practice as men from
the other schools. With the exception of re-
search Avork, AAdiich Ave ncATr taught, they
shoAved up as Avell as those of any school in
the country. Some of you Avonder hoAV a
l)ody of young doctors, most of them Avithout
a college education, stood up in coni])etition
AA'ith men so fitted. Time demonstrated that
it made little or no difference. AVe had some
A^ery splendid college men in our mixed
classes of that time, but the passing of years
did not demonstrate their marked superiority.
At the present time, Avhen all medical stu-
Continued on page 186
180
The Journal of the Maine Medical Association
Mortality in Acute Appendicitis
AI^ALYSIS OF 615 CASES IlST A SMALL COMMUNITY HOSPITAL
Hakey Brinkman, M. D., F. A. C. S., Fnrminglon, Maine
To the writing of articles on acute appen-
dicitis, like to the making of books, there is
no end. The stndy of this very important
subject has been intense, and so many ar-
ticles have been written, that the addition of
another requires some sort of justification
lest one be guilty of simply adding to the
confusion. The only justification I have to
offer is that self-examination is one of the
best forms of discipline. So long as statistics
do not come home to roost they remain bnt
cold facts which affect us bnt little. It is only
by self-analysis that one can hope to discover
one’s errors and to seek methods of avoiding
them as far as possible in the future. I have
therefore undertaken to review all of the
cases of acute appendicitis, both simple and
those complicated by perforation, which have
been operated upon in this hospital since its
opening. Cases of so-called interval and in-
cidental appendectomies have been purposely
omitted for aside from some unforeseen com-
plication or some error due to human falli-
bility this procedure should carry with it a
negligible mortality rate.
This series of cases lias been divided into
four groups, acute appendicitis without per-
foration, acute appendicitis with recent per-
foration, either at the time of removal or be-
fore peritonitis had developed, ajipendicitis
with abscess formation, and finally appendi-
citis with diffuse peritonitis.
Mortality Rates in the Four Groups
No. of
No. of I’ercentage
Diagnosis
Case.s
Deaths
^lortality
Acute appendicitis, not pert-
orated
: 535
1
0.18%
Acute appendicitis, recent
perforation
: 21
2
9.50%
Acute appendicitis with ab-
scess formation
: 16
6
37.50%
Acute appendicitis with dif-
fuse peritonitis
; 42
12
28.57%
Carcinoid appendix
: 1
0
0.0
TOTALS
: 615
21
3.41%
As noted in the chart, this study includes
015 cases diagnosed clinically as acute ap-
pendicitis plus those in which complications
developed as a result of perforation of the
appendix. Patients that undergo appendec-
tomy while the infection is limited to the
appendix itself show an average mortality
throughout the country of less than 1%. Pa-
tients as a rule do not die of appendicitis —
they die of complications which arise from a
spread of the infection beyond the confines
of the organ itself. In our group there was
one death in the 530 cases of acute appen-
dicitis in which, although many were gan-
grenous, no mention was made of perforation
in the operative note. This is a mortality
rate of 0.18% which is low indeed.
In the entire series of 615 cases there was
a total of 21 deaths, a mortality rate of
3.41%. This corresponds closely to many
other and larger reported series in the litera-
ture. An interesting fact is that of the 615
cases there were 22 patients over 60 years of
age, the oldest 90 years, and in these 22 cases
there were 8 deaths, a mortality rate of
36.3%. Obviously, appendicitis is a very
serious disease in the aged, the outcome in
one-third of the cases being fatal.
From the foregoing it is evident if the
acutely inflamed appendix is removed before
perforation occurs that a very low mortality
ensues except in the aged. There can be no
question as to the advisability of early ap-
pendectomy. It is, however, in the cases
where perforation has occurred and the in-
fection is no longer confined to the appendix
that the problem of appropriate treatment
arises. Perforation of an appendix may oc-
cur slowly or it may occur within a very
short time and this fact may in a large meas-
ure determine the subsequent course of the
disease. The infection may become localized
by the defense reactions of the body resulting
in an appendiceal abscess or it may rapidly
Nineteen Hundred and Forty-two — August
spread and produce the diffuse form or
spreading’ peritonitis with wliicli we are all
so familiar.
From the chart it wdll he seen that our
highest mortality rate occurs iii the group of
cases of appendicitis with abscess formation,
a group which according to many observers
should carry a much lower mortality rate if
properly handled. Our mortality rate in the
10 cases so reported was 37.5%, much higher
than most reports in cases of this type. Why
should this he so f liudoubtf'dly some of
tliese deaths resnlt from what Bower and his
associates^^^ call Operative-Induced Spread-
ing Peritonitis, lie says, and I think cor-
rectly so, that it is in this group of cases
where errors of commission can markedly iii-
tlueuce the final outcome. AVdieii the infec-
tion, which has now gone l)eyoud the appen-
dix, is in tlie process of being localized, the
inadvertent l)reaking down of this localiza-
tion either by instruments or the inquisitive
finger searching for the appendix may well
cause a spreading peritonitis resulting fatal-
ly. A small localized abscess may well be
absorbed if left alone but if disturbed sufli-
ciently may well flare uj) and become a lethal
lesion for as these writers say, ‘Mndividiials
recover or die from sj) reading })eritonitis just
as they do from a pneumonia or a spreading
cellulitis because they do or do not develoj)
a general and local tissue immunity. Doses
of antigen, clasmatocytic response, and anti-
toxin formation are as important in one as
in the other.” I believe that in the early
stages of abscess formation, before the pa-
tient has had sufficient time for adequate
antitoxin formation, that local cellular re-
sponse in the peritoneal cavity is very impor-
tant. It is frequently observed that patients
witli recently perforated appendices with ob-
vi(jus contamination of the peritoneal cavity
who have an abundant amount of cloudy
fluid, that is, fluid with a high leucocyte
count, can be primarily closed after appen-
dectomy and go on to an uneventful recovery
be cause of the presence in the fluid of high
numbers of polymorphonuclear leucocytes
which can immediately phagocytize the lib-
erated bacteria. This has been quite conclu-
sively demonstrated by Steinberg^'^^ and
others in their work with Coli-Bactragen. It
181
would seem that the common practice of as-
pirating or sponging out this cloudy fluid
after the removal of a gangrenous or recently
perforated appendix is one to be discouraged.
On the other hand, if one finds a localized
abscess in the presence of a clear fluid it
would seem that the danger of inducing a
spreading peritonitis by breaking through
the wall of protection is very great. Flere
one finds few pha gocytes and bacterial pro-
lification can proceed and may never be over-
come by the delayed appearance of the leuco-
cytes. We recently had a case which illus-
trated this point very well. The case was one
of a boy of 8 years of age wlio was admitted
with a palpable and visible mass in the right
hnver aI)dominal quadrant, fe^*er and leuco-
cytosis one w^ek following an attack of pain
typical of acute appendicitis. A diagnosis of
perforated appendicitis with abscess forma-
tion was made. Ilis general condition was
excellent. An incision was made over the
dome of the mass with the hope of entering
an abscess. On exposing the peritoneum it
was found that the peritoneum Avas free. It
was carefully opened and considerable clear
fluid was found. An inflammatory mass was
found just beneath and this was attached pos-
teriorly and laterally and surrounded by ad-
herent omentum. The incision was closed
and another made lateral to the first one at a
point at which the mass appeared adherent
to the parietal peritoneum. However, the
peritoneum was again found free and the
peritoneal cavity was again entered. No ap-
proach seemed possible to open the abscess
without contaminating the general peritoneal
cavity. A gauze pack was placed against the
abscess wall and brought out through the
wound for later drainage much as is often
done for brain or pulmonary abscesses. It
was hoped that the abscess might drain spon-
taneously or if not, to remove the pack after
18 to 72 hours and do a secondary drainage.
After (>I hours, on removing the pack, it was
found that the abscess had been almost com-
pletely absorbed. The hoy made an unevent-
ful convalescence, his temj)eratnre declining
steadily. I feel sure that had we broken
down the mass and attempted removal of
such an appendix in the presence of an un-
prepared peritoneal cavity where there was
182
clear Huicl with a low cell count, the outcome
would have beeu different. He might have
survived hut lie would have had a stormy
time.
It is in this group of perforated cases where
localization is taking place that one can eas-
ily harm instead of benefit the patient by be-
ing too zealous in our attempts to remove the
appendix. Once localization has begun, and
this can frequently be determined from the
history and physical findings, the period of
urgency has passed. However, more often
one cannot be sure of exactly what is taking
place within the abdominal cavity and it
would therefore seem advisable in all but ex-
ceptional cases to operate as soon as the con-
dition of the patient warrants, in order to
determine the state of affairs. The only point
I wish to emphasize is that one should ofien
the abdomen with extreme care. If one opens
into the general abdominal cavity and finds
an inflammatory mass involving the appen-
dix, too energetic search with tlie finger is
very likely to break down the protective zone
surrounding it and free an overwhelming
amount of antigen at one time into the peri-
toneal cavity for which it is unprepared. Our
mortality of 37.5% iu this group, which is
much higher than most reports iii this type
of case, bears this out. If an abscess is found
gnd the incision is not so placed so as to be
aide to o])en tbe dome of it without contami-
uatiiig the free peritoneum one shonhl not
hesitate to close the incision and make an-
other which will provide a more advanta-
geous approach. The problem of immediate
couceru is to ])revent spread of tbe infection
and not to lamiove the a])pcndix. If the ab-
scess can b(‘ drained and the a[)pendix re-
moved at the same time, well and good, but
if not, it should be left in situ to be removed
at a later date.
i\'OW let us look at the cases of so-called
spreading or diffuse peritonitis ; cases in
which no evidence of localization can be
found. By spreading peritonitis is meant
those cases in which the inflammatory pro-
cess has spread to involve a large portion of
the peritoneal cavity. How much of the peri-
toueum is iiivolved cannot be determined at
operation, for if it is, it denotes as Ladd has
so well said, a very “improper operation.”
The Journal of the Maine Medical Association
Spreading peritonitis is characterized by dis-
tention, generalized rigidity and tenderness,
rajjid pulse, temperature usually over 101°
b\, vomiting, and no evidence of a definite
mass. Of these cases, we have had 42 with
12 deaths, a mortality rate of 28.57%. This
is a high mortal it}^ rate and corresponds
closely with many other similar reports. By
what means, if any, can we hope to reduce
this figure? First of all, one must know
something of why patients with peritonitis
die. As we all have perhaps observed and as
reported by lYright and his colleagues
these patients reveal an adynamic ileus with
distention of the entire gastro-intestinal tract
with elevation of the diaphragm, basal com-
pression of the lungs, a terminal pneumonic
])rocess in the bases, splanchnic dilatation
and circulatory failure. These patients die
of intestinal obstruction and toxemia result-
ing in circulatory failure and shock. The
three important factors in the treatment of
this condition are rest, both local and gen-
eral, decompression, and the maintenance of
hydration and chemical balance.
By all odds, morphine is the drug of choice
for obtaining both general and local rest. It
relieves pain, induces sleep, adds tone to the
atonic intestinal musculature without in-
creasing peristalsis. It should be given in
ade(piate dosage to the point of relative com-
fort without too marked a res])iratory depres-
sion.
Ilie marked distention with the elevation
of the diaphragm and l)asal compression of
the 1 rings leads to considerable respiratory
difliculty and anoxemia for which oxygen can
often be jrrofitably given. Iflie compression
(‘an best be combated with tlie continuous as-
])iration set-uq) as devised by Waugensteen.
Iliis Inis been a great factor in the treatment
of intestinal obstruction of the adynamic
tyjie. Certaiidy the indiscriminate use of
cathartics, enemata, and peristaltic stimu-
lants such as pitressiii and jirostigmine
shoidd be discouraged. The intranasal cath-
eter often fails to a[)preclably relieve disten-
tion, particularly if used late when normal
jieristalsis in the stomach has gone and the
tip cannot be carried into the duodenum.
Usually the earlier aspiration is instituted,
the better are the results.
Nineteen Hundred and Forty-two — August
183
These })atieiits with nausea and vomiting,
inability to take fluids, or as a result of con-
tinuous aspiration, soon become dehydrated
with a loss of normal chlorides resulting in
alkalosis. This is best overcome by the ade-
(jiiate administration of parenteral llnids.
The amount of llnids that a patient requires
can best he determined by iioting the urine
output — according to Coller*'"^ enough should
1)C given to maintain a daily excretion of
urine of 1000 to 1500 cc. Enough physio-
logical saline should be given to keei) the
blood chloride level near to normal, the re-
mainder of the fluid given as 5% glucose in
distilled water. To accom])lish this reciuires
at least a basic amount of 3500 cc.-2000 cc.
for the insensible loss through respiration
and perspiration and 1500 cc. to compensate
for the output of urine. In addition to this,
enough must be given to overcome the dehy-
dration and other losses such as result from
continuous aspiration, vomiting, etc. Once a
patient is in chloride balance, it may be
roughly maintained by replacing the fluid
lost through aspiration rvith physiological
saline and the remainder as 5% glucose in
distilled water. For the severe toxemia re-
])eatcd transfusions of whole blood are per-
haps most effective. The place of drugs of
the sulfonamide grou}), x-ray thera])y, and
anti-toxins have as yet not l)een established
but do })romise to have a place in the future
treatment of peritonitis.
What should be done surgically for the pa-
tient entering the hospital with a perforated
appendix and presenting the picture of a dif-
fuse peritonitis'^ Xot a few of tlu' leading
surgeons are ardent advocates of the delayed
operati(UL nupliod of treatment and can pre-
sent statistics which seem to substantiate
their view. ITidoubtedly many of the argu-
ments for this form of treatment are sound
and for certain of the cases may be the meth-
od of clioice. Patients recover or do not re-
cover from ]ieritonitis depending upon the
degree of their general and local tissue resis-
tance and immunity. To inq)ose nj)on an
extremely ill patient a surgical operation
may be suflicient to tip the balance adversely
and result fatally. The battle in peritonitis
is fought to a large degree within the peri-
toneal cavity itself. Steinberg’s^^^ work on
peritoneal reactions and protection which has
been substantiated by C'oller and others work-
ing with him shows that the rate of neutro-
pliilic proliferation and phagocytosis as com-
pared to the rate of bacterial proliferation in
the peritoneal cavity is all important in de-
termining the outcome in ])critonitis. One
can almost prognosticate (*ases of this type by
studying smears of the ])eritoneal exudate. If
the smears show large numbers of l)acteria
with few leucocytes and meager phagocytosis
the prognosis is grave. If, however, there are
seen few or no free bacteria and large num-
l)ers of leucocytes, the prognosis is good. kSur-
vival depends u])on the rapid disappearance
of the bacteria and this depends upon the
adequate cell res])onse within the ])eritoneal
cavity. Therefore, any procedure which ad-
versely affects this protective reaction or en-
hances absorption 1)V the peritoneum sucli as
the mopping out of the peritoneal cavity with
gauze which removes the endothelial cells
from the surface shoidd be avoided. On the
other hand, it would seem that if au a})])en-
dix can l)e removed without t(m much delay
or trauma, it should be done for it may well
be a continuous source of infection and the
severity of the infection depends not only on
a qualitative but also upon a quantitative fac-
tor. Xo patient, however, shonld be subject-
ed to surgery until shock, distention, and d(^-
hydration have he(“n partially overcome. The
condition of a ])atient who has been ill two,
three or more days can often be improved
and made more tit for surgery by several
hours of su])])ortive treatment rather than to
subject him to a laparotoniy the same hour
that he is admitted. Idle least that seems ah-
solutely necessary surgically sliould be (hme.
Undoubtedly patients will continue to
come to us for whom nothing curative can he
done but many reports in the literature liear
witness to the fact that the mortality rate re-
sulting from the perforation of an acutely
inflamed appendix can be substantially re-
duced l)v giving practical application to cer-
tain physiologi(*al principh*s with wliicli we
are all familiar.
Continued on page 186
184
The Journal of the Maine Medical Association
Henocli s Idiopathic Purpura
By Henry G. Hadley, M. J)., Washington, D. C.
Purpura means cutaneous hemorrhage,
and where it is comhined with colic it is
called Henoch’s purpura after his descrip-
tion in 1874:d This disease is related to
various erythemas,- urticaria and angio-
neurotic edema. ^
This condition uiay occur with or without
purpura, and where purpura is absent many
have undergone surgical operations for
attacks which have resembled appendicitis.
These abdominal symptoms are colicky in type
and are due both to internal hemorrhages
and to swelling and distention of the bowel. ^
There is edema in a large proportion of cases,
which occurs on the face, hands, and feet.
This may or may not be associated with
disturbances of renal function.
In the blood examination there is a normal
or slightly prolonged coagulation time, and
the platelets may be normal or somewhat
reduced. The symptoms are anaphylactoid^
in nature, and it is probable that this form
of purpura is associated with infection*’, as
in other anaphylactic reactions such as serum
disease there is swelling and puffiness about
the eyes and face. There may be no fever
or only a slight rise in temperature.
The purpuric lesions are usually confined
to the skin and do not appear on the mucous
membranes, but hemorrhages are not common.
This disease may not only simulate abdom-
inal disease' bnt may cause it, as in a case
of apj^endicitis with perforation reported by
Uderman®. The administration of Vitamine
C, which has been suggested because of the
slight similarity to scurvy, is of no practical
importance.
Tlie platelets may be increased by Vita-
mine C therapy,*' but this is attributed to
direct stimulation of the bone marrow. The
vitamine does cause an in vitro acceleration
of clotting,^" bnt treatment does not ])roduce
any definite clinical results.
Case Report
Gay Mally, white male, age 8, was first
seen on March 22, 1940. The most promi-
nent symptom was the frequent appearance
of colicky abdominal pains which prevented
the child from sleeping and would cause him
to assume grotesque attitudes in his attempt
to secure relief. There was a typical pur-
puric eruption over the extremities and was
more marked on the thighs. Recovery was
gradual, and the last symptom to disappear
was the abdominal colic.
Laboratory report : Blood count, red
4,()40,()00 ; white 21,900. Polys 54%, Band
26%, Lynip. 16%. Platelets 113,120. Kahn
test negative. Vitamine C content of the
l)lood only one-third of normal. Examina-
tions of the stool consistently showed blood.
Bibliography
1. Henoch, E. H. “Ueber eine eigenthumliche
Form von Purpura.” Berlin Klin. Wchnschr.,
11; 641-643, 1874.
2. Osier, W. “The Visceral Lesions of Purpura.”
Brit. Med. 1; 517, 1914.
3. Withington, C. F. “Visceral Purpura and
Angioneurotic Edema.” Boston M. S. J ., 166:
511, 1912.
4. Johannessen, C. “Purpura.” Norsk Mag. f.
Laegevidensk, 79; 1209-1336, 1918.
5. Bateman, D. “Two cases of anaphylactoid
(Henoch-Schonlein ) purpura.” Proc. Royal
8oc. Med., 32: 327-329, Feb., 1939.
6. Cellina, M. “Sindrome di Schonlein-Henoch
in corso di angina streptococcica. Ripro-
duzione delle manifestazioni cutanee in seguito
ad iniezione intradermica di filtrato di brodo-
cultnra streptococcica,” Haematologiea, 19:
891-905, 1938.
7. Froment, R., Monnet, P., and Letorey. “Formes
cliniques des complications abdominales du
purpura.” Lyon Med., 163:465-471, Apr. 23,
1939.
8. TJderman, S. I. “Henoch-Schonlein’s disease
in etiology of acute abdominal syndrome. ”
Sovet Vracli Zhur, 42: 527-530, Oct. 15, 1938.
9. Gotti, L. “L’influenza della Vitamine C nelle
diastesi emorragiche.” Hematologica, 16; 923-
981, 1935.
10. Kuhnan, .1. “Der Mechanismus der Vitamin-
wirkungen.” Yerlimid d. deutsch. gesellsch f.
inn. Med. Kong., 46: 415-426, 1934.
11. Lunedei, A., and Giannoni, A. “La Vitamine
C nella terapia delle diatesi emorragiche.”
Riv. di Clin. Med., 36; 319-364, May 15-30, 1935.
Nineteen Hundred and Forty-two — August
185
The Presidents Page
To the Members of the Maine Medical Association: —
On July 26th, the Council met at Bayview Farm, Belfast, all members being present.
Among items of business considered at the meeting it was voted that each Councilor
report at the October Council meeting the wishes of the County Societies of his district
concerning the nature of the 1943 Annual Session of the Association. Let every mem-
ber give this matter some serious thought and thus assist your officers in making a
proper decision as to this meeting in 1943.
A word concerning "The Doctor at Home.” "So much to do, so little time in
which to do it.” These words are attributed to Sir Cecil Rhodes — in the year of his
death. They might be spoken today by every American Doctor of Medicine.
Doctors in military service will find their schedule arranged for them. Those of
us who must remain at home must find ways to increase our efficiency. Members of the
profession who have the task of carrying on at home will find that the demands made
upon their time will become increasingly heavy, not only for the duration of the war
but for some years to come. To conserve our strength, thus increasing our efficiency, we
must look carefully into our use of time. Most of us are unable to plan a schedule of
our day’s work in advance and are forced by urgency and circumstances to work
through the day and into the night in a somewhat haphazard way. We should try to
protect ourselves from interruption and time wasted.
In some foreign countries the polite guest always waits for his host to rise first and
thus indicate that the time has come for the guest to leave. Might we not imitate this
custom to good advantage and make it a habit to rise and plead an urgent call when-
ever our time is being taken by unimportant matters.
Most of us become fatigued because we take on more work than we should do.
Let’s follow the advice we give our patients as to proper rest and relaxation. People need
to be reminded, and in many cases taught, that during the war, doctors have no time
to waste and that it is to their advantage to help to keep their own doctor from being
exhausted through over work.
The time has come when it is necessary to face the fact that all of us at home,
while the younger members are in the military service, must do much more work than
in normal times.
To increase our efficiency without unduly hastening our physical and mental im-
pairment it will be necessary for us to scrutinize our use of time and to have the fortitude
to make the necessary alterations in our activities. We who are at home should devote
as much time as circumstances permit to our Civilian Defence Program. Let’s assist, in
every way we can, our State Medical Director of Civilian Defence, Albert W. Moulton,
M. D., of Portland, and our local organizations in this important work.
Let every Doctor of Medicine encourage donations to the Blood Plasma Banks of the
State, that his community may not suffer from the lack of this modern life-saving
measure in time of need.
As you all know, opportunities for service in Civilian Defence are unlimited. As a
profession let us do our part in preparation of the Home Front.
Carl H. Stevens, M. D.,
President, Maine Medical Association.
186
The Journal of the Maine Medical Association
Ayi Old-Fashioned Medical School — Contimied from page 179
dents are college graduates, there is no basis
for comparison.
The Medical School of ]\raine, like all
other schools in the period I am descrilnng,
taught principally hy the lecture system, sup-
])lemented hy quizzes. The lecture system of
that day was a wonderful means of impart-
ing instruction to a class of considerahle size,
and no teacher Avas a marked success unless
he Avas a good lecturer. The time came Avhen
there AA^as a dearth of medical lecturers. Edu-
cators affected to despise this system hut I
think those Avho disparaged it AA^ere those Avho
AA^ere nnahle to carry it out. It must he ad-
mitted in its faAmr that a system of instruc-
tion Avhich enabled a medical school to take
recruits from the ranks of toil, graduates of
the farm and shop, and in three years time
e(piip them so that they compared faA^orahly
AAntli college graduates and Avere able to coni-
})6te AAutli them on oath terms, Avas a good
system.
As a matter of fact^ our professors and
teachers taught more than medicine, and the
course giA^en AA’as in many res])ects a fair suh-
stitiite for an academic education. The
course of lectures in Anatomy hy Dr.
Frederic Henry Gerrish Avas equivalent to a
course in English Avith a fair amount of
Latin, ])robably as much as Avas needed in
the practice of ineAlicine. Dr. Franklin C.
Ivobinson taught Chemistry Init incidentally
easily, and it seemed naturally, Avorked in a
large amount of practical science. Dr. Alfred
]\Iitchell taught Pathology and Practice, and
Avithout effort included philosophy, economics
and ethics. Other members of the teaching
staff made generous contribntions, for there
Avere giants in those days; intellectual giants.
You knoAv l)etter than T about medical
schools and medical education at the present
time, and yon jn-obably knoAV something
about the cost. One of our successful sur-
geons of fairly recent times told me that the
cost of his medical education after leaving
high school and paid of course, by his father,
Avas ajDproximately tAventy thousand dollars.
Assuming the extreme cost of medical educa-
tion in my day as being two thousand dollars,
his education cost him ten times as much.
Admitting that he may be a l)etter man, is he
ten times as good ? It is not for me to judge ;
but to break even, he should have accumu-
lated at the end of his life a competence ten
times as great and should live to practice ten
times as long, regarding Avhich Ave may cer-
tainly entertain grave doubts. There is no
chance of medical education returning to the
extreme simplicity that characterized it in
1897, but there is a possibility that the eco-
nomic situation may change it someAvhat.
Some of you may live to see it.
Mortality in Acute Appendicitis — Continued from page 183
(1) BoAver, John O.; Burns, John C.; Mengle, Har-
old A.: “Induced Spreading Peritonitis Com-
plicating Acute Perforative Appendicitis.”
S. G. 0. 1938, 66:947.
(2) AVright, TheAv; Aaron, A. H.; Regan, .1. S.;
Milch, Elmer: “Management of Patients Avith
Diffuse Peritonitis.” J. A. M. A. 113:1285,
9/30/39.
(3) Coller, F. A.: “Studies in Water Balance,
Dehydration, and the Administration of Paren-
teral Fluids.” Minyi. Med. 19:490, July, 1936.
(4) Steinberg, Bernhard: “The Experimental
Background and the Clinical Application of
the Esch. Col and Gum Tragacanth Mixture in
Prevention of Peritonitis.” Am. J. Clin. Path.
6:253, May, 1936.
(4) Coller, F. A.; Brinkman, H. : “Studies on the
Reaction of the Peritoneum to Trauma and
Infection.” Annul of Surg., 109:942, 6/39.
(5) Coller, F. A.; Ransom, H. K.; Rife, C. S.:
“Reactions of the Peritoneum to Trauma and
Infection.” Arch, of Surg. 39:761, Nov., 1939.
Tlie liealtli of the people is really the and all their powers as a state depend. —
foundation upon Avhich all their happiness Disraeli.
187
Nineteen Hundred and Forty-two — August
Editorials
To Each a Duty
.Ml of you should now he fauiilinr with the
])roo'i'am of the Procurement and Assig’umciit
Service, the Selective Service Act, and the
])ur|)ose of the l\laine IMcdical Officers' Re-
cruitiii”' Board at 81 Western Avenue, Au-
ii'usta. But at this writing- IMaine is still he-
hind in sup])lying its quota of ])hvsiciaus
needed for the Armed F orccs.
Every ]diysician under F5 years of age,
physically fit, and not engaged in an ess(‘utial
occupation, must 1)C made available to the
armed forces. .Vgain we urge you who have
]iot already done so to go at once to your
Recruiting Board and apply for your Com-
ndssion. Don't wait for the draft.
We are engaged in an ‘hill out war,” every-
body’s war, and a war that will recpiire the
services of every physician, either in the
armed forces or on the home front.
The hoys in our armed forces need every
one of you under 4-5 years of age, who is
physically fit and declared available by the
state board of procurement and assigiimeiit
service. Don’t let them down.
Our civilian population who are engaged
in defense production, on the farms, or in
maintaining the homes of these workers, need
you wdiose duty it is fo remain af home.
Your task will be a hard one, maybe not as
colorful as that of those in service but equally
as im2)ortaut. Many of you who have carried
on your practice for many years and seek re-
tirement must again “hang out your shingle,”
in order that the younger doctors may be
made available for service.
Proceedings at the Ninetieth
Annual Session
The stenographic report of Proceedings at
the fSTinetieth* Annual Session, House of
Delegates, Election of President-elect, and
Scientific Sessions, has just been received
at the Association office. The transcript of
Proceedings at the First and Second Meet-
ings of the House of i^elegates, and the Elec-
tion of the President-elect, are now being
edited for pid)lication, which Avill start with
the Sepember issue of the Jouuxal and l)e
continued in the Octol)er and Xovember
issues.
These reports of proceedings at the House
of Delegates meetings are the records of the
deliberations of the legislative body of your
Association com])oscd of delegates elected by
the component county Societies and the offi-
cers of the State Association. They contain
the report of the Council for the year just
past, the Budget for the new year, the re-
port of your Delegate to the American Medi-
cal Association annual meeting ; reports of
Delegates to AHw England State ]\Iedical So-
ciet}-' annual meetings ; the appointment of a
Reference and a Xominating Committee, and
the reports of these committees ; reports of
committees not piddished in the June issue of
the -TounxAn; discussion and action on new'
business brought before this body ; in fact, a
detailed record of the business transacted by
the governing body of your Association.
The election of the President-elect took
place on i\londav afternoon, June 22nd, in
accordance wuth the Association By-Law'S,
Chapter TV, Section T, wdiich states “The
election of President-elect shall be by direct
ballot in the general asseml)ly of the Associa-
tion at the close of the first general afternoon
session,” and the report null be ])ublished fol-
lowung the Proceedings of the House of Dele-
gates.
These records arc published, not only in
order that we may have a permanent record
in the pages of the JouRAmn, but in order
that every inemher of this Association may
read them and familiarize himself with the
w'ork of the delegates from the county socie-
ties, and the officers of the state association,
in carrying on the purposes of this Associa-
tion ; “To promote the science and art of
medicine, the protection of public health, and
the betterment of the medical profession ; and
to unite wuth similar organizations in other
States and Territories of the United States
to form the American Medical Association.”
Don’t miss reading these reports.
The report of proceedings at the Scientific
Sessions wull be published in conjunction
wuth papers presented at these sessions.
188
The Journal of the Maine Medical Association
Medical Division
Office of Civilian Defense
State Hospital Officers
Appointed
The Medical Division of the Office of
Civilian Defense annonnces the appointment
of State Hospital Officers in coastal States
to direct the hospital program of the Emer-
gency Medical Service under the State chiefs
of Emergency Medical Service.
The following hospital officer has l)een ap-
pointed a consultant in the Public Health
Service for part-time duty :
Maine: Mr. O. K. Lermond, Thomaston.
The duties of these hospital officers will
be: to survey rural hospital facilities suit-
able for use as Emergency Base Hospitals,
to supervise personnel arrangements for the
Base Hospitals and reception centers for evac-
uated civilians, to collaborate with State
chiefs of the Emergency IMedicnl Service in
controlling movements of medical and nurs-
ing staffs as well as of casualties in any situa-
tion affecting Emergency Base Hospitals and
to perfect arrangements for transporting pa-
tients evacuated from (iisualty Beceiving
Hospitals.
Consultants on OCD Blood and
Plasma Program
Tinder the program recently launched l)y
the Medical Division of the Office of Civilian
Defense and the TJ. S. Public Health Service
to provide plasma for the treatment of ci-
vilians injured in warfare, regional consid-
tants have been appointed to advise hospitals
on technical problems related to the establish-
ment of blood and plasma banks.
Dr. Ered Bryan, Rochester, H. Y., is the
consultant for the Eirst and Second Civilian
Defense Regions and a jiart of the Third
Region. Dr. Elmer L. DeGowin, Iowa City,
is acting as technical consultant on special
problems. The blood and plasma bank pro-
gram is at present confined to vulnerable
areas within 300 miles of the ocean and gulf
coasts. The Subcommittee on Blood Substi-
tutes, Division of IMedical Sciences, Rational
Research Council, serves in an advisory ca-
pacity to the Medical Division of the Office
of Civilian Defense as it does to the Medical
Departments of the Army and Ravy and the
American Red Cross.
New Appointments
Dr. David D. Bidstem-, chief of the cardiac
Imreau of tlie Rew York State Department
of Health, Albany, lias been appointed to the
staff of the Medical Division, Office of Ci-
vilian Defense, Washington, D. C., as medi-
cal gas officer to organize instruction for
physicians of Eastern States in the medical
aspects of chemical warfare.
A native of Wilkes-Barre, Pa.. Dr. Rut-
stein graduated from Harvard University,
Cambridge, Mass., in 1930 and from Har-
vard Medical School, Boston, in 1934. Eor
the next eighteen months he served as house
officer on the Second Medical Service at the
Boston City Hospital and in the academic
year 1936-1931 was assistant in bacteriology
and research fellow in pediatrics at Harvard
Medical School. In 1937, Dr. Rutstein was
appointed medical consnltant to the bureau
of pneumonia control of the Rew York State
Department of Health, Albany, and con-
tinued in that capacity until January, 1941,
when he became chief of the cardiac bureau.
He is now on leave from that position.
Nineteen Hundred and Forty-two — August
189
Home Study Courses for Members of the Maine Medical
Association
Eeeause of tlic war many features of Post-
^■aduate ]\Ledical Education will be seriously
curtailed or given up. It has lieeu deemed
necessary to post])oue the X. E. Postgraduate
i\fedical .Vsseud)ly for the duration. The
formal courses, offered to memhers on Eel-
lowships from the Commonwealth Euud and
the Bingham Associates, are gradually being
discontinued. Travel is becoming increas-
ingly ditiicult so that attendance at various
staff groups and sectional meetings will not
be as constant as formerly. And yet it is
most essential that every effort be made to
keep the standards of medical service at a
high level of efficiency.
With more of onr younger physicians going
into the Army or Xavy, the available medical
service must assume greater burdens. Older
men will have to l)econie increasingly active
both in hospitals and in private practice. With
greater demands upon the individual physi-
cian it becomes increasingly important that
he be given every possible aid in keeping
abreast of present-day scientific achieve-
ments, and that this be done without the
necc'ssity of his travelling away from home
and his professional responsibilities. For the
physician located in an active hospital group
this does not present the same problem as for
the man situated more or less alone in a rural
community. The hospital must assume the
responsibility for Continuation Education in
the former case, while the latter is left more
or less to his own devices.
With the idea of meeting the requirements
of the large group of physicians, a program
of Home Study (Purses was authorized by
the House of Delegates at the last annual
meeting. This })rogram will Ix^ largely de-
signed to assist in organized reading, suggest-
ing pertinent up-to-date subjects with whicli
the physician should be conversant and pro-
viding ready references in tlu' literature. It
follows a plan of Home Study Courses which
lias been conducted by the American Acad-
emy of Ophthalmology and Oto-larvngology
for the last three years.
Clmrses will be offered in General kfedi-
cine, Surgery, Obstetrics and (iynecology and
in Pediatrics. These courses will he stricth'
clinical, endeavoring always to furnish mate-
rial of practical value. These will be avail-
able without cost to members of the klaine
iMedical Association, njion application to the
State Secretary’s office. It is phuim'd to send
out material periodically to each applicant.
A physician may apply for one or more of
tliese courses, just as he desires. Committees
of recognized specialists will have charge of
these different courses.
Following this will be found an application
blank which can be tilled out and sent to
Frederick II. Carter, M. 1)., 1-12 High Street,
Portland, IMaine. This is all that is necessary
to enroll in these courses. This should be
done without delay as it is desired to start
these courses in September.
CoM-MITTEE ox GrAUUATE EdUCATIOX,
E. T. IIiLE, ]\[. I)., Chairman.
Feedeeick II. Caetee, H. 1)., Secretary,
Afaine Aledical Association.
, 1942
ITease enroll me in the Home Study Course for General Aledicine — Surgery — Obstet-
rics and Gynecology — Pediatrics. (Strike out courses not desired.)
(Signed)
(Address)
, AI. D.
190
The Journal of the Maine Medical Association
COUNTY SOCIETIES
Androscoggin
President, Camp C. Thomas, M. D., Lewiston
Secretary, Charles W. Steele, M. D., Lewiston
Aroostook
President, Thomas G. Harvey, M. D., Mars Llil!
Secretary, Clyde I. Swett, M. D., Island Falls
Cumberland
President, Roland B. Moore, M. D., Portland
Secretary, Eugene E. O’Donnell, M. D., Portland
Franklin
President, James W. Reed, M. D., Farmington
Secretary, George L. Pratt, M. D., Farmington
Hancock
President, Ralph W. Wakefield, M. D., Bar Flarbor
Secretary, M. A. Torrey, M. D., Ellsworth
Kennebec
President, L. Armand Guite, M. D., Waterville
Secretary, Frederick R. Carter, M. D., Augusta
Knox
President, James Carswell, M. D., Camden
Secretary, A. J. Fuller, M. D., Pemaquid
Linco In-Sagadahoc
President, Edwin M. Fuller, Jr., M. D., Bath
Secretary, Jacob Smith, M. D., Bath
Oxford
President, Albert P. Royal, M. D., Rumford
Secretary, J. S. Sturtevant, M. D., Dixfield
Penobscot
President, Albert W. Fellows, M. D., Bangor
Secretary, Forrest B. Ames, M. D., Bangor
Piscataquis
President, Fred J. Pritham, M. D.,
Greenville Junction
Secretary, Norman H. Nickerson, M. D., Greenville
Somerset
President, Allan J. Stinchfield, M. D., Skowhegan
Secretary, M. E. Lord, M. D., Skowhegan
Waldo
President, Lester R. Nesbitt, M. D., Bucksport
Secretary, R. L. Torrey, M. D., Searsport
Washington
President, Perley J. Mundie, M. D., Calais
Secretary, James C. Bates, M. D., Eastport
York
President, Carl E. Richards, M. D., Alfred
Secretary, C. W. Kinghorn, M. D., Kittery
County News and Notes
Aroostook
The Annual Meeting of the Aroostook County
Medical Association was held at Houlton, Maine,
June 10, 1942.
At the evening session Dr. Samuel Proger, Bos-
ton, spoke on Some Medical Diagnostic Prol)lems.
Many interesting case reports were presented and
the method of arriving at the diagnoses explained.
The following officers were elected for the com-
ing year;
President: Thomas G. Harvey, Mars Hill.
Vice-President: Francois J. Faucher, Grand Isle.
Secretary - Treasurer : Clyde I. Swett, Island
Falls.
Gkkali) H. Dox.aiute, M. D.,
Secretary.
New Members
Oxford
David Davidson, J\I. D., Greenwood Mountain,
Maine.
GiseJa Kaufer Davidson, M. D., Greenwood
Mountain, Maine.
Change of Address
Kennebec
Roscoe L. Mitchell, M. D.
From; 15 Johnson Heights, Waterville, Maine.
To: 111 Western Avenue, Augusta, Maine.
Oxford
Norman M. Jackson, M. D.
From : Andover, Maine.
To: 17 South Street, Middlehnry, Vermont.
Deaths
A ndroscoggin
Anthony D. Pelletier, M. D., 36, of Lewiston,
was accidentally drowned on July 4, 1942, while
on a fishing expedition at Rangeley.
191
Nineteen Hundred and Forty-two — August
Doctors of the Maine Hospital Unit
Doctors of the 67th General Hospital, first affili-
ated hospital unit from Maine, which will prob-
ably be called to service about September 1st;
Commander; Lieut.-Col. Roland B. Moore, of
Portland. Doctor Moore served two years in
World War I, and for more than a year was
Assistant Division Surgeon of the 76th Division,
and Adjutant of the Hospital Center, Commercy,
France. After the Armistice he was an officer of
the American Military Mission to Berlin.
Chief of Surgical Service; Lieut.-Col. Stephen
A. Cobb, of Sanford. Doctor Cobb served in World
War I, at Camp Jackson and Greene, and as Cap-
tain at Base Hospital 54 in France.
Chief of Medical Service; Lieut.-Col. Elton R.
Blaisdell, of Portland. Doctor Blaisdell has been
Associate Chief of Medical Service at the Maine
General Hospital for several years, and is at pres-
ent Acting Chief.
Majors;
Milton S. Thompson, Portland
Jack Spencer, Portland
Philip H. McCrum, Portland
Edward A. Greco, Portland
Alvin A. Morrison, Portland
Henry M. Tabachnick, Portland
Eaton S. Lothrop, Portland
Charles W. Steele, Lewiston
William V. Cox, Lewiston
Merrill S. F. Greene, Lewiston
Wilfred J. Comeau, Bangor
Carl E. Richards, Alfred.
Captains ;
George C. Poore, Portland
E. Allan McLean, Portland
Alvin E. Ottum, Portland
Gordon N. Johnson, Portland
Albert C. Johnson, Portland
Eugene P. McManamy, Portland
Otis B. Tibbetts, Lewiston
Bertrand A. Beliveau, Lewiston
Paul R. Chevalier, Lewiston
Edward W. Holland, Sanford
Charles W. Eastman, Livermore Falls
Ralph E. Williams, Freeport
Gerald H. Donahue, Presque Isle
James W. Reed, Farmington
Maynard B. Colley, Wilton
Paul C. Marston, Kezar Falls
Joseph A. Villa, South Paris.
First Lieutenants;
Walter G. Dixon, Norway
John R. Merrick, Portland
Joseph G. Ham, Portland
C. Lawrence Holt. Portland
Harry E. Christensen, Portland
J. Robert Downing, Kennebunk
Rosario A. Page, Caribou
Gilbert Clapperton, Lewiston.
The unit sponsored by the Maine General Hos-
pital under the direction of Roland B. Moore, M.
D., has been in the process of organization since
July, 1940, will form the personnel of a base hos-
pital of 1,000 beds, with a staff of 48 doctors, 7
dentists, 18 administrative officers, 105 nurses, and
400 enlisted men of the Medical Department.
Notices
Tumor Clinics
Bangor: Eastern Marne General Hospital
Thursday, 11.00 A. M.-12.00 M.
Director, Magnus F. Ridlon, M. D.
Bureau of Health
Services for Crippled Children
Clinic Schedule
Lewiston: Central Maine General Hospital
Tuesday, 10.00 A. M.-12.00 M.
Director, E. C. Higgins, M. D.
St. Mary's General Hospital
Wednesday, 4.00 P. M.
Director, R. A. Beliveau, M. D.
Portland: Maine General Hospital
Thursday, 11.00 A. M.-12.00 M.
Director, Mortimer Warren, M. D.
Waterville: Sisters Hospital
1st & 3rd Thursdays, 10.00 A. M.
Director, B. 0. Goodrich, M. D.
Thayer Hospital
2nd & 4th Thursdays, 10.00 A. M.
Director, E. H. Risley, M. D.
Bangor: Eastern Maine Geyieral Hospital
Thursday, 1.00 P. M.-3.00 P. M.;
September 3, October 1, Novem-
ber 5, December 3.
Waterville: Thayer Hospital
Thursday, 1.30 P. M.-3.00 P. M.;
August 27, October 29, December
31.
Rockland :
Portland:
Knox County Hospital
Thursday, 1.30 P. M.-3.00 P. M.;
August 20, November 19.
Children’s Hospital
Monday, 9.00 A. M.-ll.OO A. M.:
August 10, September 14, Octo-
ber 12, November 9, December 14.
192
The Journal of the Maine Medical Association
Fort Kent: Normal School
Monday, 9.00 A. M.-ll.OO A. M.,
sometimes from 1.00 P. M-.3.00
P. M. also. August 24, Octo1)er
5, December 7.
Presque Isle: Northern Maine Sanatorium
Tuesday, 9.00 A. M.-ll.OO A. M., 1.00
P. M.-3.00 P. M.: August 25, Oc-
tober 6, December 8.
Lewiston: Central Maine General Hospital
Saturday, 9.00 A. M.-ll.OO A. M.;
August 29, September 26, Octo-
ber 24, November 21, December
19.
Rumford: Rumforcl Community Hospital
Wednesday, 1.30 P. M.-3.00 P. M.:
August 19, October 21, December
23.
Machias: Normal School
Wednesday, 1.00 P. M.-3.00 P. M.;
October 14, .January 20.
Portland Children’s Hospital
Cardiac: Tuesday, 9.00 A. M.-ll.OO A. M. :
August 11, September 8, October
13, November 10, December 8.
Lewiston St. Mary’s Hospital
Cardiac: Friday, 1.30 P. M.-3.00 P. M.: Au-
gust 28, September 25, Octol)er
23, November 20, December 18.
N. B. This clinic schedule is subject to change.
If changes are necessary adequate notice will be
given.
Please destroy previous schedule.
V etiereal Disease Clinics
For the information of physicians wishing to
refer cases of venereal disease for treatment, the
State Bureau of Health announces that such facili-
ties are available in the following locations:
Augusta, Bangor, Bath, Belfast, Biddeford, Bing-
ham, Calais, Danforth, Eastport, Ellsworth, Grand
Isle, Guilford, Houlton, Island Falls, Lewiston,
Millinocket, Old Town, Portland, Presque Isle,
Rockland, Rumford, Sanford, Waterville, Wilton,
Winthrop.
Any physician wishing to refer a case may
obtain the name of the clinic physician, in the
town where the patient is to receive treatment, on
request to the Director, State Bureau of Health,
Augusta, Maine.
The American Congress of Physical
Therapy
The American Congress of Physical Therapy
will hold its twenty-first annual scientific and
clinical session September 9, 10, 11 and 12, 1942,
inclusive, at the Hotel William Penn, Pittsburgh,
Pa. The annual instruction course will be held
from 8:00 to 10:30 a. m. and from 1:00 to 2:00 p. m.
during the days of September 9th, 10th and 11th
and will include a round-table discussion group
from 9:00 to 10:30 a. m., Thursday, September 10th.
The scientific and clinical sessions will be given on
the remaining portions of these days and Saturday
morning. A new feature will be an hour’s demon-
stration showing technic from 5:00 to 6:00 p. m.
during the days of September 9th, 10th and 11th.
All of these sessions and the seminar will be open
to the members of the regular medical profession
and their qualified aids. For information concern-
ing the seminar and program of the convention
proper, address the American Congress of Physical
Therapy, 30 North Michigan Avenue, Chicago, 111.
Training Physical Therapy Technicians
Columbia University announces that beginning
September, 1942, a program of professional studies
for the training of Physical Therapy technicians
will be offered. This training and instruction will
extend over a two-year period and has been organ-
ized in compliance with the requirements set down
for such programs by the Council on Medical Edu-
cation and Hospitals of the American Medical
Association. The course is being set up in Uni-
versity Extension in close relationship with the
College of Physicians and Surgeons of Columbia
University, the Nursing Education and Health and
Physical Education Departments of Teachers Col-
lege. The clinical and laboratory instruction will
be given at the Vanderbilt Clinic, Neurological
Institute, Presbyterian Hospital and New York
Orthopedic Dispensary and Hospital.
Two years or 60 semester hours of college, in-
cluding courses in Physics and Biology, shall be
required, or graduation from an accredited School
of Nursing or an accredited School of Physical
Education.
A Certificate of Proficiency in Physical Therapy
will be granted by Columbia University to those
completing the course. Further information may
be obtained by writing the Office of the Committee
on Physical Therapy, Room 303B, School of Busi-
ness, Columbia University, New York City.
American College of Surgeons
- The 1942 Annual Meeting of the American Col-
lege of Surgeons will be held at Chicago, October
19-23. Frederic A. Besley, M. D., 40 E. Erie Street,
Chicago, Secretary.
Mississippi Valley Medical Society
The Eighth Annual Meeting of the Mississippi
Valley Medical Society at Quincy, 111., Sept. 30,
Oct. 1, 2.
Second Annual Meeting of the Mississippi Val-
ley Medical Editors’ Association, at Quincy, 111.,
Sept. 30.
Nineteen Hundred and Forty-two — August
The American College of Physicians Will
Hold Its 1943 Session in Philadelphia,
April 13-16, 1943
The American College of Physicians has an-
nounced its 27th Annual Session to be held in
Philadelphia, Pa., April 13 to 16, inclusive, 1943.
Heretofore, the College has held a five-day Session,
but in the interest of conserving time and expense
of its members, the program will be condensed into
four days, Tuesday through Friday. Dr. .James E.
Paullin, Atlanta, as President of the College, will
have charge of the program of General Sessions
and Lectures. Dr. George Morris Piersol, Philadel-
phia, as General Chairman, will be responsible for
the program of Hospital Clinics, Panel Discussions,
local arrangements, entertainment, etc. The gen-
eral management of the session and technical ex-
hibits will be handled by the Executive Secretary,
Mr. E. R. Loveland, 4200 Pine St., Philadelphia.
Legal Mediciyie
On Wednesday, September 30, 1942, the Massa-
chusetts Medico-Legal Society and the Department
of Legal Medicine of Harvard Medical School will
unite in an all-day conference at the Mallory
Institute of Pathology, Boston City Hospital. Idere
numerous subjects of medico-legal interest will be
discussed and demonstrated. To this meeting
medical examiners, coroners, physicians interested
in these subjects, state or local legal olRcials or
193
police authorities are cordially invited. Immedi-
ately following this session, the Department of
Legal Medicine of Harvard has arranged for a
more intensive post-graduate course to be held on
October 1, 2, 3, 8, 9, and 10. This will include close
study of many post-mortem investigations made
from the medico-legal standpoint and the various
procedures associated with possil)le crime detec-
tion, attendance limited to six. For the conference
on September 30th, preliminary registration only
is required. For the post-graduate course, a small
fee will be made. Further information may be
obtained from the Department of Legal Medicine,
Harvard Medical School, 25 Shattuck Street, Bos-
ton, Massachusetts.
For Sale
2 Instrument Cabinets, 3 Filing Cabinets, 3 In-
strument Tables, 2 Sterilizers, and a variety of
general surgical instruments. Can be bought very
reasonably.
For Rent
Suite of Offices: 4 rooms. Receptionist in
attendance.
Mrs. William D. Anderson,
29 Deering Street,
Portland, Maine,
Telephone 2-5222.
Book Reviews
^‘The Treatment of Infantile Paralysis in
the Acute Stage”
By : Elizabeth Kenny.
Published by Bruce Publishing Company, Minne-
apolis, Saint Paul, 1941. Price, $3.50.
Here is a book on positive therapy during the
acute stage of anterior poliomyelitis, written by a
woman, apparently not a Doctor of Medicine, just
Sister Kenny. Sister Kenny has enthusiastically
and persistently tried since the year 1933 to prove
to the medical profession of England, Australia
and North America that in the Kenny treatment
she has something to offer to the sufferers of an-
terior poliomyelitis which commands immediate
consideration and widespread application. Many
of her statements are so positive and the results
of the recorded treated cases so encouraging that
the book ought to be read and the Kenny method
investigated and employed in all suitable patients
by all who are caring for persons afflicted with
anterior poliomyelitis in the acute state. Among
the many quotable statements which are made by
the author are: “I have evolved a satisfactory and
commendable treatment for the disease, poliomye-
litis, in the acute stage which holds out more hope
for recovery than any yet seen anywhere else, and
that my methods introduced original conception
in the treatment of this disease.” ... “I have proved
that the disease, infantile paralysis, presents symp-
toms utterly disregarded and pronounced to be
non-existent in the orthodox theory.” . . . “Suffi-
cient proof has l)een given that the paramount
principle of orthodox treatment, immobilization,
prevents the treatment for the symptoms present-
ing themselves and induces the majority of the un-
desirable conditions mentioned.” . . . “It has been
agreed by all observers that deformities did not
develop in patients treated by the Kenny system,
nor has there been any necessity, to date, to apply
any artificial supports to any of the patients we
have received early enough to restore mental
awareness of the part.” . . . “The reason for this
more successful result is that the disease presents
symptoms unknown to all other observers.” . . .
“Therefore, I consider it is necessary that this truth
should be spread throughout your great Fnited
States of America and elsewhere.” ... “I unhesi-
tatingly state that the whole future of the patient
depends upon treatment in the acute stage of the
disease.” Reading of such remarkable successes
fills one with new enthusiasm for greater effort at
successful therapy in acute anterior poliomyelitis.
194
The Journal of the Maine Medical Association
“Manual of Standard Practice of Plastic
and Maxillofacial Surgery”
Prepared and Edited by the Subcommittee on
Plastic and Maxillofacial Surgery of the Com-
mittee on Surgery of the Division of Medical
Sciences of the National Research Council,
and Representatives of the Medical Depart-
ment, U. S. Army.
Robert H. Ivy, Chairman
John Staige Davis
P. C. Lowery
Joseph D. Eby
Ferris Smith
Brig. Gen. Leigh C. Fairhank, Medical Depart-
ment, tJ. S. Army
Lt. Col. Roy A. Stout, Dental Corps, U. S. Army
With Contributions by John Scudder and F^reder-
ick P. Hangen.
Published by W. B. Saunders Company, Philadel-
phia & London, 1942. Price, $5.00.
This book represents Volume One of a series of
six which are about to appear under the common
title: Military Surgical Manuals of the National
Research Council. Volume Two will be entitled:
Ophthalmology and Otolaryngology; Volume Three:
Abdominal and Genito-uriiiary Injuries; Volume
Four: Orthopedic Subjects; Volume Five: Burns,
Shock, Wound Healing, and Vascular Injuries;
Volume Six: Thoracic Surgery, Neuro-surgery,
and Peripheral Nerve Injuries.
The purpose of the series is directive. It pro-
vides a standard of practice and accomplishment
in treatment and management of injuries to aid
the surgeon in the discharge of his duties. The
line of duty between the physician and the patient
presenting his casualty is followed systematically
from the battalion aid station on through the
collecting station, evacuation hospital and finally
to the general hospital. The guidance provided by
these manuals is possessing authority which must
be accepted by every surgeon in service. “The
surgeon should not be permitted to deviate from
these standards unless his practice can be fully
justified.’’
“Methods of Treatment in Postencephalitic
Parkinsonism”
By: Henry D. von Witzleben, Elgin State Hos-
pital, Elgin, Illinois.
Published by Grune & Stratton, New York, 1942.
Price $2.75.
On 135 pages of text the author informs the
medical reader on the various forms of treatment
which have been employed in an effort to alleviate
the suffering of persons afflicted with postenceph-
alitic Parkinsonism. At present the only therapy
which gives any measure of lasting comfort is the
Bulgarian Treatment combined with physical ther-
apy. These are described in detail. There are 20
pages of bibliographic references for the benefit of
those who wish to study source material.
“Diseases of Women”
By: Harry Sturgeon Crossen, M. D., F. A. C. S.,
Professor Emeritus of Clinical Gynecology,
Washington University School of Medicine;
Gynecologist to the Barnes Hospital, St.
Louis Maternity Hospital, and St. Luke’s
Hospital; Consulting Gynecologist to DePaul
Hospital and the Jewish Hospital; Fellow of
the American Gynecological Society and of
the Central Association of Obstetricians and
Gynecologists; and Robert James Crossen,
A. B., M. D., Assistant Professor of Gynecol-
ogy and Obstetrics, Washington University
School of Medicine; Assistant Gynecologist
and Obstetrician to the Barnes Hospital and
the St. Louis Maternity Hospital; Assistant
Gynecologist to the St. Luke’s Hospital and
to DePaul Hospital; Fellow of the Central
Association of Obstetricians and Gynecolo-
gists; Diplomate of American Board of Ob-
stetrics and Gynecology.
Ninth Edition. Entirely Revised and Reset.
With 1,127 Engravings, including 45 in color.
Published by The C. V. Mosby Company, St.
Louis, 1941. Price, $12.50.
The present, ninth edition, of this great work is
brought up to date in all important features. In
theory and practice the authors have incorporated
everything that they have found to be helpful to
the practitioner. Whatever is known better today
than a decade ago concerning the diagnosis and
treatment of gynecologic complaints is known
chiefly because of our better understanding of the
physiologic and pathologic activities which are
constantly in progress but possessing the inherent
tendency to vary from day to day. Crossen and
Crossen continue to keep the profession well in-
formed.
“Medical Clinics of North America”
Volume 25 — Number 6 — November, 19il
Military Medicine
Published by W. B. Saunders Company, Philadel-
phia and London. Paper, $12.00 per Clinic
Year; Cloth, $16.00 per Clinic Year.
This is an excellent symposium on Military Med-
icine l)y twenty-seven contributors. In short, terse
language all necessary and practicable information
concerning medical service to men active in the
defense forces is here presented to the reader.
True to the requirements of present-day warfare,
that is, total warfare, all phases of military medi-
cine are presented in the knowledge that the active
fighting forces are now functioning as groups of
specialists in total warfare, fast moving, highly
trained, technically integrated teams which must
always be kept in efflcient readiness to cooperate
for coordinated action. It seems that this book
should be made availal)le to every physician,
whether he be active in the front-line or the home
defense forces.
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“Functional Pathology”
By: Leopold Lichtwitz, M. D., Chief of the Medi-
cal Division of the Montefiore Hospital;
Clinical Professor of Medicine, Columbia
University, New York.
Published by Grune and Stratton, Inc., New York,
1941. Price, $8.75.
Functional pathology is that branch of medical
science which analyses the causes, signs and symp-
toms of aberrations of normal function of the
human organism. The book under review presents
detailed resume of careful scientific study of the
various mechanisms, stimulations and processes
Avhich are thought to form the bases for the many
abnormal or pathological complaints for the re-
moval of the symptoms of which the patient con-
sults the physician. The contents of the book is a
record of the author’s thirty years of thorough-
going observation and study. Considering the fact
that the author not only chose to study and record
material contained within a sphere so large in
scope and so difficult to penetrate as pathologic
physiology, but also chose to record the fruit of
his life-long work in a language which is not his
native tongue, his work is one of the best of this
type in the English language. By choosing new-
sounding terms, such as mechanisms of defense,
and angiospastic diathesis, for instance, he gives
us a new kind of a look-in on complaints due to
allergic action, angina pectoris, migi’aine, and
others. As we learn to think of what is written in
this and many other chapters, we will learn to
better understand the large group of sufferers
from so-called neurotic or hypochondriac or hy-
steric complaints, such as pains in head, neck,
back and nerves, or “rheumatism,” or drowsiness,
cold hands and feet, and many others. MTren a
patient complains of definite physical discomfort
the physician cannot afford to advise “to think
nothing of it” without permitting the patient to
go into full detail and permit himself to study in
detail the possibility of localized momentary im-
pairment of body fluid flow and equilibrium. Since
this book is written as a direct result of the
author’s findings during his personally conducted
studies, many of the opinions are at variance with
the orthodox or typical textbook presentation of
the subject— pathologic physiology; it should en-
courage more or less lively discussion among the
experts of the orthodox school.
“N euroanatomy”
By: Fred A. Mettler, A. M., M. D., Ph. D., Profes-
sor of Anatomy, University of Georgia School
of Medicine, Augusta, Georgia.
With 337 Illustrations, including 30 in Color.
Published bv The C. V. Mosby Company, St. Louis,
1942. Price $7.50.
This very excellent textbook has been written
primarily for the needs of the medical student
engaged in the study of neuroanatomy and the
practical application of the acquired knowledge
during his clinical training. However, secondarily,
it is a very necessary text for all graduates who
wish or need to keep themselves well informed on
the terminology of neuroanatomy, both old and
new. as well as classic or Latin. The text is organ-
ized along progressive lines, always keeping in
mind that the material presented must be consid-
ered as being necessary for the medical student of
neuroanatomy. For further study more specific
texts in the special fields of medicine are required.
There is appended an excellent list of selected
references.
XIII
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The Journal
of the
Maine Medical Association
Uolume Thirt^'-three Portland, Ulaine, September, 1942
No. 9
Subluxation of Distal End of Ulna'^'
r. W. Kujilix, M. I)., Bangor, Maine.
Snblnxation of the distal end of the nlna
has become a distinct clinical entity, to be
considered as a complication of fractures and
dislocations about the wrist joint. A study of
the literature does not reveal a single large
series of cases, dne to the fact that a fractured
wrist which functions well after union is con-
sidered a good result, and interest is lost when
the acuteness of the fracture has passed and
the patient is again attending to his daily
routine. Unfortunately, there are a small
number of these subluxations which produce
symptoms and disability; then relief is
sought primarily for pain and loss of func-
tion ; secondly, for cosmetic reasons.
Illustration 7— The typical deformity of subluxa-
tion of the ulna. This case was associated with a
fracture of the distal end of the radius.
The etiological factor and pathological pic-
ture have remained constant throughout the
literature. Trauma forceful enough to fracture
or dislocate the distal end of the radius is suf-
ficient to dislocate the distal end of the ulna,
and is the outstanding factor. The direction
of the force and anatomical structures should
be considered. From the outstretched hand,
the force is transmitted through the carpal
Ixmes to the distal end of the radius which
fractures with a posterior displacement of
the lower fragment. There is also a force-
fidly supinated and lateral force introduced,
with a resulting rupture of the ulna attach-
ment of the triangular ligament. The ulna
has no articulation at its distal end with the
exce})tion of its articulation with the distal
end of the radius, so it exerts a downward and
lateral force which aids in the “rupture” of
the triangular ligament and allows the wrist
to widen, which, in turn, ruptures the anterior
and posterior ulno-radial ligaments. The more
elastic pronator quadratns remains intact.
* From the Service of Dr. A. Steindler, Department of Orthopedic Surgery, The State University of
Iowa Hospitals.
198
A — Radius
B — Aina
C — Posterior Carpal ligament
D — Anterior Carpal ligament
E — Triangular ligament
F— Medial Carpal ligament
G — Pisiform
H — Radial Carpal ligament
Illustration II — Original diagramatic drawing
showing the ligamentous structures which main-
tain the normal relationship between the distal end
of radius and ulna.
Snjipiirative diseases wliich destroy tlie
distal iiliio-radial articidatioii and relaxes or
destroy tlie retaining apparatus about the
wrist joint will also produce a siibliixation of
the distal end of the ulna.
Arthritis has been mentioned as an ex-
citing factor. The subluxation was produced
by a relaxation of the ligamentous structures
which undergo a degenerative change of the
distal end of the ulna and the production of
exostosis.
Jones and Lovett describe subluxation as
Madelung’s deformity and state that when
the deformity is not due to one distinct force,
it may be brought about by a series of minor
trauma over a long period of time.
Among the short series of nine cases in the
files of the Department of Orthopedic Sur-
gery, eight were complications of fractures
and one case was evidently of a congenital
nature, showing that trauma was the out-
The Journal of the Maine Medical Association
standing etiological factor in this particular
series.
Key states that subluxation of the distal
end of the ulna may occur as an isolated
injury due to a hypersupination of the wrist
joint.
The incidence of subluxation of the distal
end of the ulna is not great, and the resulting
deformity and disability are of secondary
consequence when one is dealing with a frac-
ture. Cotton reviewed the literature in 1912.
Colles did not describe the pathological pic-
ture, and probably the first mention of a
subluxation of the radio-ulnar articulation
was described by Desault during a post-
mortem examination. Forty years later,
Dupuytren described one case. A review of
the literature in 1907 revealed that only
twenty-eight cases had been reported. The
fact that the subluxation may occur without
trauma has been shown by Eliason, also
Magnusson, both writers stating that the liter-
ature offers fifty cases which have occurred
without trauma. These cases were of the
congenital type or those cases which develop
from repeated minor trauma.
The signs and symptoms make the diag-
nosis of subluxation of the distal end of the
ulna relatively easy, while the X-rays offer
little or nothing toward an explanation of
the symptoms unless the styloid process of
the ulna is fractured. With fracture of the
styloid, one may conclude only that the tri-
angular ligament has been ruptured at this
particular point of attachment. Arthritic
changes in the lx)ne will also be revealed by
X-ray.
The distal end of the ulna may be luxated
toward tlie ventral or dorsal aspect of the
wrist, and there is usually a lateral deviation
of the lower end. The head of the ulna is
always prominent. It is because of this prom-
inence that many people seek relief, and has
in cases been the indication for carrying out
an operative procedure which will be de-
scribed later.
The mobility of the radio-ulna articulation
tends to produce an unstable joint. The distal
end of the ulna is freely movable, but always
tends to return to the original deformity.
The motion, although free, is springy in
type and characteristic.
Nineteen Hundred and Forty-two — September
The motion of the wrist joint proper is
little impaired, but pain is elicited when the
forearm is supinated and pronated. The pain
is usually located at the radio-ulna articula-
tion or at the styloid process of the ulna. The
supinatory and pronatory motions of the
forearm is carried out by internal and ex-
ternal rotation of the shoulder joint.
The patient will complain of weakness of
the wrist joint, and there is the inability to
carry out finer movements. A history of
trauma is es})ecially important.
A review of the operative technique leads
one to believe that each author and operator
has his own method. A brief summarv of
many of these techniques will be made, and
those which seem worth while will be dealt
with in some detail.
Von Mayer, in 1925, advocated the use of
an external l)and of leather or bandage to
give support to the wrist. This seemed in-
adequate, especially in chronic cases.
Darrach’s operation of resecting the distal
end of the ulna did not inhibit motion of the
wrist joint, but did tend to disturb the
stability due to the loss of the distal end of
the ulna.
Behrand nailed both bones together by
0})en operation, but did not attempt to resect
the ulna. Umpiestionably, the anatomical
landmarks were retained, but this technique
eliminated the pro and supinatoiy motion of
the forearm.
Bogna used the fascial strip and introduced
the necessity of suturing the fascia to neigh-
boring tissue in order to obtain stabilization.
His fascial grafts were passed from the ulnar
styloid to the carpal bones. Bogna operated •
in two cases and stated he had excellent results
during five years, and stabilization of the
joint was adequate.
Tvey and Cromwell drill through both ulna
and radius, run a fascial strip through the
drill holes and suture it. It would seem from
the description that the supination and pro-
nation of the forearm would be limited.
Idiey state that the period of post-operative
immobilization should be six weeks.
Wilson and Cochrane list one case in which
they got excellent results. They repaired the
triangular ligament at its point of rupture.
A fascial ligament was then sutured to the
199
ulna styloid and carried to the dorsum of the
radius, where it was sutured. This was evi-
dently a ventral dislocation. Their excellent
result was based on the following facts ;
That they obtained a stable, painless, good-
functioning joint that from all appearances
was anatomically correct.
J. Allen Berry of Hew Zealand, in his
article of January, 1981, written in the
British Journal of Surgery, believed that the
Gallie operation is the one of choice. This
operation is rather complicated and may lead
to a poor result should one get a pseudo-
arthrosis between the distal end of the radius
and the ulna. An attempt is made to fuse
the distal radial and ulna articulation. The
ulna is then resected above this attempted
fusion. The arm is placed in plaster until
the fusion is complete.
Sauve and Kapandji, in the June, 1985,
issue of the Journal de Chirurgie, describe
the techni(pie of Bazy and Galtier and com-
pare it with their own. Galtier and Bazy
make use of a fascial sling about the distal
end of the ulna. This is done with difficulty,
as it necessitates a resection of the pronator
qnadratus. A drill hole is made antero-
posteriorly through the radius and the fascia
threaded through it and sutured. The opera-
tion necessitates the use of two incisions, one
on the dorsal and one on the ventral surface
of the wrist. Their comment on this tech-
nique is that one encounters difficulty in the
dissection.
Sauve and Kapandji, in descril>ing their
own technique, state that it is not difficult
and offers a well stabilized, good-functioning
arm, with a cosmetic correction and free
from the possibility of non-union. To the
technique of Gallie, they add a metal screw.
A dorsal incision is made and the pronator
qnadratus resected at its broad ulna insertion.
The radial ulnar articidation is resected to
further fusion of this joint. A metal screw,
4 cm. long, is placed first through the distal
end of the ulna, traversing the resected radial
ulnar articulation, and entering the distal
end of the radius. The ulna is then resected
above the metal screw, as is done in the Gallie
technique. A portion of the pronator quad-
ratus is passed through the resected ulnar to
prevent a union between the proximal and
distal fragments of the resected nliia. The
authors report uniformly good results from
this technique.
The final coutrihutioii to American litera-
ture was contributed by Eldridge F. Eliason
of Philadelphia. Here, again, the fascial
loop is made use of, but the mechanics have
been taken into consideration. The technique,
however, seems difficult. Two ventral and
two dorsal incisions are necessary. The ven-
tral and dorsal incisions are longitudinal and
used to approach the dorsal and ventral
aspects of the ulna and radius. Sharp dis-
section is used thronghont. The pronator
qiiadratns is dissected from its ulna attach-
ment. Fascia lata is used and sutured longi-
tudinally to form a tnbe-like structure. A
drill hole is now made in the radius and tra-
verses the distal end of the radius in a
diagonal plane, i. e., from the medial in-
ferior border to the lateral dorsal aspect.
The fascia is drawn tightly and then sutured
well to the dorsal surface of the radius.
Eliason lists two cases that gave equally good
results. The author had the chance to inspect
the functional results of the fascial loop as
he explored the dorsal ulna incision of one
case and found the loop functioning well.
Jones and Lovett advise against operating
on cases of subluxation of the distal end of
the ulna. They recommend the use of a
wristlet and a persistent course of physical
therapy.
The following is a short resume of the
cases admitted to the wards and private serv-
ice of this institution. Of the nine cases
admitted, all were a result of trauma with
the exception of one case. All nine cases
admitted were treated by a conservative
regime by use of a leather wristlet. Four of
these cases came to open operation. All four
cases were operated on by ditferent operators,
and four distinct techniques were used. In
The Journal of the Maine Medical Association
three cases, a fascial strip was used. In one,
Gallie’s techique was used, with a resulting
pseudo-arthrosis, and had to be reoperated.
This case ended in a good result.
O
Illustration III — Same case as illustrated above.
The deformity was corrected by the Gallie tech-
nique.
All four cases reported a relief of pain.
Two of the four cases reported had a slight
subluxation of the distal end of the ulna,
although they had relief of pain and a good-
functioning joint.
CoxcLUsiox :
1. Subluxation of the distal end of the
ulna will result from trauma and not infre-
quently fonnd as a complicating factor re-
sulting from fractures about the wrist joint.
2. Subluxation of the distal end of the-
ulna is a distinct clevical entity which pro-
duces pain and instability of the wrist joint.
3. Cases which do not respond to conserv-
ative treatment obtain relief from operative
procedures.
BiBLIOCtUAPHY
1. British Journal Surg., January, 1931.
2. Industrial Medicine, 4:417-420, August, 1935.
3. Annals of Surgery, 96:27-35, 1932.
4. Journal de Chirurgie, 47:589-595, April, 1936.
5. Key and Cromwell.
6. Cotton, Fractures.
7. Fractures, Magnuson.
8. Jones and Lovett.
9. Fractures and Dislocations, Wilson and Coch-
rane.
10. Orthopedic Surgery, Whitman.
Indiana, Eentucky, Few Jersey, Oregon
and Washingfon are on the roll of states
which have laws calling for a specific exam-
ination of all school personnel in contact with
children. Other states vary widely in their
programs but in most states there are some
communities offering voluntary tuberculin
tests or local board rulings requiring specific
examinations for tuberculosis of applicants
for teaching positions. — Report of Nafl
Tuber. Sept., 1941.
Nineteen Hundred and Forty-two— September
201
Medicine and Air Supremacy^'
By Toirx F. Fulton, M. D.,j- ISTew Haven, Connecticut
George Clieyne Sliattnck, the younger
(1813-93), whose father, George Cheyne
Shattnck, the elder (1784-1854:), left the be-
quest that led to the founding of this lecture-
ship, died early in 1893, and Osier, ^ who
gave the fourth lecture of the series in that
year, chose for his subject “Tuberculous
Pleurisy,” a theme in which the younger
Sbattuck liad been interested since his early
days in Paris, when he studied under the
great French clinician, Louis. Shattnck’s
son, Frederick Cheever Shattnck (1847-
1929) was, like his father and grandfather,
a great force in Hew England medicine. The
Shattncks were men of humor, forthright
candor and passionate loyalty to the tradi-
tions of this country. Their humor is well il-
lustrated in a lively encounter between Fred-
erick Cheever Shattnck and Harvey Cushing,
who gave the Shattnck Lecture in 1913." Dr.
Shattnck had read Cushing’s account of the
Western Beserve and its traditions,^ and was
horrified to find the word tomahawk mis-
spelled. Dr. Cushing, his secretariat and the
Cleveland proofreaders had all passed
“tommyhawk” — spelled like “tommy-gun.”
This was too much for Frederick Cheever,
who immediately commandeered conveyance
to the Peter Bent Brigham Hospital, and,
wearing a pair of enormous plus fours,
dashed in the side door of Dr. Cushing’s office
to tell him that the ]\Eoseley Professor of Sur-
gery, who had been born in the Western Re-
serve out among the Indians, should know the
spelling of tomahawk ; not content with this,
he wrote Cushing a letter referring him to
the Ceniury D ictioniiry .
* * ** ->5-
I have said that the Shattncks were men of
intense loyalty to this country’s traditions,
and when your committee requested aviation
medicine as the subject of this discourse, it
seemed obviously a theme wholly appropriate
for a lecture devoted to the memory of this re-
markable line of American physicians ; more-
over, a topic with military implications is not
without precedent, for just twenty-five years
ago, — in June, 1917, — Dr. AValter B. Can-
non gave a Shattnck Lecture on traumatic
shock. In accepting the honor, I have, how-
ever, taken on a heavy responsibility, and one
that for various reasons is embarrassing.^
The Hational Research Council and the
Office of Scientific Research and Develop-
ment have followed the policy of classifying
as “confidentiar’ or “secret” all topics hav-
ing to do with offensive instrumentalities of
war. The airplane is clearly such an instru-
mentality, as are many of the devices within
the plane designed to improve the perform-
ance of the pilot in his rapid, high-altitnde
maneuvers ; so that medicine, perhaps for the
first time in its history, has come to be di-
vided, so far as war is concerned, into otfen-
sive and defensive spheres. Advances that
have to do with increasing the effectiveness of
human performance in combat become mili-
tary secrets, and cannot now be openly dis-
cussed. Defensive measures, on the otlier
hand, designed for treating the wounded,
either civilian or military, or for prophylaxis,
as by inoculation, fall into the category of de-
fensive measures and can be freely described.
Aviation medicine falls squarely across the
broad categories of offense and defense, and
I am therefore obliged to devote attention
2)riniarily to the defensive jDhases of the
subject.
It has become obvious, even to the most
casual observer, that air sujDremacy will de-
termine tlie outcome of the present war.
8hi2)ping still has vast importance and we
look carefully to our tonnage, but all the
ships of the United Hat ions would become
virtually useless without command of the air.
Sn23reniacy in aviation is not wholly a ques-
* The Shattnck Lecture, delivered at the annual meeting of the Massachusetts Medical Society,
Boston, May 26, 1942.
From the Laboratory of Physiology, Yale University School of Medicine,
t Sterling Professor of Physiology, Yale University School of Medicine.
** Reprinted from The Neio England Journal of Medicine, Vol. 226, No. 22, Page 873.
202
The Journal of the Maine Medical Association
tion of more and faster planes with gi’eater
firing power than the enemy. This, to he
sure, is important, hut equally so is the prob-
lem of securing well-selected, well-trained
and adequately protected flying personnel.
The performance of modern aircraft has far
outstripped the physiological limitations of
the pilot. The newer combat planes can fly
higher than is compatible with life, even
when the fliers are breathing pure oxygen.
They can perform maneuvers causing centri-
fugal force of such intensity that blood tends
to be drawn away from the brain, a condition
that results in transient blindness (blacking-
out) and unconsciousness. And, finally, the
range of the modern four-motored bombers
— some of which can remain for twenty-four
hours in the air — has raised problems of pilot
fatigue, severe stresses and strains from cold,
psychological tension and loss of sleep that
impair the performance of flying personnel.
It is the responsibility of medicine in its
broadest sense, including psychology, psychi-
atry, physiology and the special branches of
clinical medicine, to protect hying personnel
from these and many other hazards that they
face. The role of the physician in both the
offensive and defensive phases of the war
effort has therefore become increasingly vital
for broad military strategy.
Air supremacy involves not only flying
personnel but ground personnel. It is esti-
mated that for every man in the air there
are nine or ten men on the gTonnd, both
in civilian airlines and in military aviation;
men on the ground are as essential as the
men in the air, and if the Army should
wish 100,000 pilots it must recruit 1,000,000
men. Air supremacy also extends to the
men in the aircraft factories, who are ex-
posed to special hazards peculiar to aircraft
production. I cannot speak of industrial haz-
ards in aircraft plants, but they are real and
their successful handling rests with indus-
trial physicians. In an aviation plant re-
cently visited, 600 from a total of 30,000 em-
ployees were treated daily for accidents or
illness occurring in the plant — that is, 2 per
cent of the total personnel became ill or were
injured each day. This is far higher than one
would wish or anticipate, and yet with the
vast expansion of the past twelve months,
such injuries are to some extent inevitable.
In a plant that is not expanding, injury rates
diminish, but usually only as rapidly as the
measures taken for their prevention. The
need for industrial physicians in all phases
of the war effort continues to be enormous.
To give a more general idea of the scope of
aviation medicine, I shall describe a classified
bibliography of the subject that is now in the
process of publication.
Literature of Aviation Meuicine
In recent months, my associates, Dr. and
Mrs. Ebbe C. Hoff, and I have had the re-
sponsibility of searching out, listing and
classifying all available literature bearing on
the medical aspects of aviation. The project
was proposed nearly eighteen months ago,
and the labor is now completed, for the bib-
liography will 1)6 published within a few
weeks. The subject matter covers a vast
range, the principal topics being indicated by
the main chapter headings of the bibliogra-
phy:
1. History and General Aspects of Avia-
tion Medicine.
2. The Special Physiology of Aviation.
(This section is divided into nineteen
subsections, including all the organ sys-
tems and special senses.)
3. The Special Pharmacology of Aviation.
4. The Special Psychology of Aviation.
5. Aeromicrobiology. (Bacteriology and
immunology in aviation and high alti-
tudes. )
6. Diseases and Accidents in Aviation and
Conditions Simnlating Flight.
7. Selection and Assessment of Efficiency
of Flight Personnel.
8. Training, Performance and Fatigue of
Flight Personnel.
9. Protection of Flight Personnel: Pre-
ventive medicine and therapeutics of
aviation.
10. Aviation and Public Health.
11. Organization of Aviation Medicine.
12. Special Problems.
13. General Studies in Aviation Medicine.
14. Bibliographies.
203
Nineteen Hundred and Forty-two — September
It may be of interest that, althongli ap-
proximately six thousand separate items were
found, the author index contains some nine-
teen thousand names, from which one must
infer that those who write on the subject gen-
erally write in trios. And this expresses what
some of ns had gTadually come to realize:
that research endeavor in this field is inevi-
tably cooperative. The flight surgeon uses a
pilot or some fellow flight surgeon as a sub-
ject of an experiment, sometimes in the air,
sometimes in a decompression chamber and
sometimes in a hnnian centrifuge. When de-
compression experiments are involved, five or
six peoj^le generally constitute a team, and
their names may appear as co-authors of the
report.
The bibliography itself cuts across the
scientific pcnlodical litc-ratiire of all })hases
of science in all conntric's, articles from about
eight hnmlred journals having Ikhui cited.
Of thes(‘, less than half are nu-dical journals.
Tn passing, one may mention that from the bib-
liographical standpoint it would he impossible to
cite a vast literature of this sort if one restricted
abbreviations to a system worked out purely for
medical journals. On this point, we were for-
tunately forewarned and at the start adopted the
conventions of A World List of Scientific Periodi-
cals" as a basis for abbreviations; this made pos-
sible the ready citation in conveniently abbrevi-
ated form of any scientific journal in any language,
without serious confusion.
In surveying this literature, we were im-
pressed Ity the large number of Japanese ar-
ticles on aviation medicine. Much more strik-
ing, however, was the fact that about thirty
Russian journals were represented in the bib-
liography, embodying a vast and well co-ordi-
nated literature on the subject — far ahead,
incidentally, of that of Japan.
There is a widespread feeling that bibli-
ography is a dull preoccupation reserved for
spinsters and old maids of the male sex.
Actually, it is far from that, for careful
analysis of the literature of any subject re-
veals trends of research, and in the bibliogra-
phy under consideration, it has exposed
trends and emphasis of far-reaching interna-
tional significance. The Germans, for ex-
ample, began publishing papers on the effects
of high acceleration in aircraft five years be-
fore the flight surgeons of the United Rations
had given any general consideration to the
problem, and everyone must realize what the
dive bomber has meant to the Axis war effort.
For better or for worse, the Allies have de-
pended largely on horizontal bombing, but
with our fast fighters we are quickly learning
the significance of high acceleration, and are
studying the modes of counteracting its
effect on aircraft personnel.
Problem of Anoxia
The responsibility of carrying on research
in the more academic phases of aviation
medicine falls largely to the civilian labora-
tories, althongli one looks forward to research
institutes within the military services that
will continue with active investigative en-
deavor in times of peace. But in the present
war crisis, it is clearly up to the civilian
scientists to undertake the long-range prob-
lems, and in aviation medicine the most basic
of these is a study of the adjustments of the
l)ody to anoxia. There are many aspects of
the problem as yet imjierfectly understood, —
individual variations, variations of the indi-
vidual,^— factors that aid the body in making
the adaptations, all of which involve funda-
mental physiological, biochemical and endo-
crinological research ; the aim in view is to
increase knowledge of the jirocesses involved
and to search out ways of improving human
performance in the higher altitude ranges.
To use the language of aviation, the basic
problem is to raise the aviator’s “ceiling.”
But from the purely academic standpoint, we
wish first to extend our knowledge of the
processes involved.
In his excellent monographic review on the
effects of anoxia in the body. Van Liere®
gives a broad picture of the manifold changes
that occur when the body is exposed to low
oxygen partial pressure. In adjusting, for
example, to a fall of half an atmosphere, giv-
ing an equivalent altitude of 18,000 feet,
there is a veritalile ionic cataclysm between
blood and tissues and renal tubules, accom-
panied by a shift of the blood pH to the alka-
line side, with an extensive loss of sodium
and chloride ions in the urine. Van Liere,
however, makes little attempt to elucidate the
important problem of how these ionic shifts
are integrated. What organ responds in the
first instance to the lowered oxygen partial
204
The Journal of the Maine Medical Association
pressure ? From the work of Cannon® and of
Gellhorn and his collaborators/®’ “ it is
known that the sympathetic system is ex-
quisitely sensitive to anoxia and that many of
the adjustments arise from the direct stimu-
lating action of low oxygen tension on the
central neurons of the sympathetic system.
From the sympathetic comes the reflex mobi-
lization of idle red blood cells from spleen,
hone marrow and other reservoirs, and a vast
series of vasomotor readjustments designed
to improve the circulation of vital organs is
brought about, also reflexly, througli inter-
action of the sympathetic and parasympa-
thetic systems. No one, however, appears pre-
viously to have suggested that the ionic shifts
essential for anoxic acclimatization are like-
wise mediated througli reflex channels. The
evidence to date is incomplete, hut suggestive,
and it turns largely on recent developments
bearing on the part played by the adrenocor-
tical hormone in anoxia.
Anoxia and Adrenal Cortex
Two papers published by Frencli flight sur-
geons at the end of the last war suggested that
the asthenia that certain aviators developed
after repeated missions to high altitudes was
due to adrenal insufliciency. FeriV® ob-
served urinary retention of nitrogen and al-
kali, low blood pressure and pathological
heart sounds in a group of over-fatigued avia-
tors, and he was led on the basis of these find-
ings to the conclusion just mentioned. The
paper of Josue^^ was based on a study of
physiological and psychological alterations in
fatigued pilots. But since at that time there
was no clear distinction between the adrenal
medulla and the cortex, the suggestion can
remain only of historical interest. More re-
cently, Armstrong and Heini^^ found on ex-
posing rabbits for four hours a day to an at-
mosphere equivalent to 18,000 feet that, in
the early stages, hypertrophy of the adrenal
gland resulted and was followed later by de-
generative changes in the adrenal cortex. In
his well-known book on aviation medicine,
Armstrong^" later pointed out that over-
fatigued pilots, especially those subjected to
many high-altitude missions, developed symp-
toms strikingly similar to those seen in early
Addison’s disease.
Sundstroem/'’’” whose early studies on the
adaptation of man to high altitudes are well
known, was led some years ago to study the
relation of the adrenal glands to acclimatiza-
tion and, independently of Armstrong and
Heim, confirmed the existence of adrenal hy-
pertrophy resulting from anoxia ; in his
monograph about to appear from the Uni-
versity of California Press, he^® shows that
the degree of adrenal hypertrophy can he
roughly correlated with the extent to which
the oxygen partial pressure is diminished.
All animals exposed to diminished atmos-
pheric pressure during the period of acclima-
tization tend to lose weight. This loss of
weight is shared, according to Sundstroem,
by all organs of tlie body except the adrenal
cortex (and possibly tlie kidney) ; the adrenal
liypertrophy is therefore regarded as some-
thing specific to tlie anoxic state. On the
basis of tho hyjiertrophy, Sundstroem asked
himself whether this might not indicate in-
creased secretion of the glands. He set out
to obtain a direct answer to the question in
two ways. In the first place, adrenal steroids
were extracted from tissues, such as the heart
and liver, from control animals at sea level
and from groups exposed to the high-altitude
ranges ; the tissues of the latter animals in-
variably showed a larger proportion of ad-
renal steroid than the corresponding tissues
in animals at sea level.
]\Iore imjiressive, however, was the study
of Giragossintz and Sundstroem,^® in which
it was found that adrenalectomized animals
could not survive in the high-altitude ranges
and that it took twenty times more crude ex-
tract of the adrenal cortex to maintain rats
at 20,000 feet than it did at sea level. This
clearly suggested that to maintain the body
at high altitude increased secretion of ad-
renocortical extract is essential.
The problem has recently been taken up
anew in my laboratory by Langley and
Clarke,"®’ who have confirmed the fact that
adrenal hypertrophy develops in rats exposed
to 20,000 feet ; and in adrenalectomized ani-
mals, they find that at sea level the mainte-
nance dosage for an average adult rat is 0.5
cc. of total extract a day (Wilson), or 0.03
mg. of desoxycorticosterone acetate. At
20,000 feet, a rat on this maintenance dose
rapidly loses weight and dies, and Langley
Nineteen Hundred and Forty-two — September
205
and Clarke find that 2 or 3 cc. of total extract
is essential at that altitude and tlnit 1 mg. of
dcsoxjcorticosterone is rc(inirod. AYlien accli-
matization has taken place, liowever, after
one week at 20,000 feet, the maintenance
dose can l)c reduced to the sea-level amount.
Langley found, as had Gerald Evans,--, that
exposure of a fasting rat to an allitude of 20,000
feet for twenty-four hours causes an elevation of
both the blood-sugar and liver-glycogen levels.
This suggests that Compound E, the carbohydrate
fraction of the adrenocortical secretion, is mobil-
ized in conditions of anoxia. But the desoxycor-
ticosterone fraction appears also to be mobilized,
since Langley has found in dogs exposed to an
altitude of 20,000 feet that a marked increase oc-
curs in sodium and chloride and also in potassium
excretion. Following adrenalectomy, dogs sul)-
jected to anoxia failed to show the sodium and
chloride excretion, although potassium loss con-
tinued. The failure of the sodium, chloride and
carbohydrate ad,iustments in adrenalectomized
animals exposed to anoxia indicates that the pres-
ence of adrenal extract is apparently essential to
make the bodily adjustments to altitude, and one
naturally wishes to know how the adrenal cortex
is specifically activated — whether directly by the
blood stream, or in some way through the nervous
system. Langley, 2n in discussing the question, re-
marks: “It is possil)le that the increase in sodium
chloride and urine volume observed in the normal
animal exposed to anoxia was brought about by
increased excretion of these specific fractions
I desoxycorticosterone I of the adrenal cortex. This
ol)servation suggests that the adrenal cortex is
capable of secreting certain components of the
whole extract independently of the others.”
Tlie recent important work of Dr. George
Thorn, tlie newly appointed TTersey Pro-
fessor of IMedicine at the Harvard Medical
School, has also established in animals that a
large increase in sodium, chloride and potas-
sium excretion occurs on exposure to anoxia,
and lie has found conspicuous nitrogen reten-
tion in man under these conditions. Treat-
ment of adrenalectomized animals with the
so-called “carbohydrate-regulating” factor
caused a striking increase in sodium, chloride
and water excretion, but no increase in potas-
sium. Thorn and his collaborators"®”"' have
just given an account of the effect on rats,
rabbits and dogs of intermittent exposure to
altitudes equivalent to 18,000 and 27,000
feet. Tdiey have confirmed Armstrong and
Heini’s^^ observation that adrenal hypertro-
phy develops in consequence of such repeated
exposure in rabbits (and also rats); they
have found, moreover, that the adrenalecto-
mized animal fails to survive repeated
“flights” to these altitudes, and that their ca-
pacity for adjustment can be restored by ad-
ministration of adrenocortical hormone.
From the studies of Collip"® and his stu-
dents, it ap])ears probable that the adrenal
cortex is normally activated, not by the blood
stream directly, but rather by the adreno-
tropic hormone of the anterior pituitary. The
ingenious work of ITotila"”’®” indicated that
the thyrotropic hormone is under the direct
control of nerve centers in the liypothalamus
whose axons passed down the ])itnitary stalk,
and that the reaction to cold results from
thermal stimulation (via the Iflood) of the
hypothalamic centers. Since the adrenal cor-
tex also plays a large part in the reaction to
cold and to anoxia, it is likely that the pri-
mary activation of the adrenal cortex comes
from the hypothalamus through the adreno-
tropic hormone. Favoring this is the fact,
oria’inallv disclosed bv Gerald Fvans"" and
recently confirmed by Catchpole,^’^ that the
chronically hy])0])hysectomized rat has no
greater altitude tolerance than the adrenalec-
tomized animal.
All this brings one to a far clearer concept
of the mode of integration of the bodily ad-
justments to altitude. The part played by the
respiratory center in the medulla has long
been recognized. ]\robilization of red cells
and the reflex adjustments of the heart and
circulaticm arise in part from direct stimula-
tion of the chemoreceptors of the carotid
body, as well as from the direct effect of low-
oxygen tension on the sympathetic system;
there a])pears to be further reflex control,
through the centers in the hypothalamus, of
the ionic pattern and carbohydrate level of
the Iflood. Undoubtedly, when the complete
})icture has been put together, the posterior
pituitary gland will also be found to play a
}>art in these adjustments through the influ-
ence of its antidiuretic hormone on the kid-
ney tul)ules. This strongly suggests that the
bodily adjustments to anoxia are in large
measure integrated liy the central nervous
system.
Safety ix Cuasiies
The military phases of aviation medicine
are rigidly practical. General academic re-
search is encouraged at some of the larger
bases and institutions, but for the immediate
purposes of the war effort a group of practi-
cal problems has arisen for which solution is
206
retiuired in a matter of montlis. Combat
fliers, for example, are constantly exposed to
rongh landings nnder black-ont conditions, or
to crash landings when machines are disabled,
and the question arises whether mechanical
factors for safety, similar to those introdnced
within the past few years in antomotive de-
sign, cannot be adapted to aircraft. This
raises the question of the factors responsible
for injuries, fatal and otherwise, in air
crashes. Close study of the large literatnre on
air crashes indicates that impact of tlie body,
es])ecially the head, with some solid part of
the aircraft is generally the cause of death or
of serions injury, even in minor accidents.
When the body or the head strikes something
that yields, as when the flier is thrown
through a fabric roof or the windshield, the
victim generally escapes serions injnry.
What, then, are the basic factors that govern
the degree of injnry in such circnnistances ?
The most significant clnes have come from
two sources: De Haven’s^' analysis of non-
fatal suicidal leaps from high bnildings, and
a study, for whicli Denny-Brown is largely
responsible, of the effects of sudden accelera-
tioii on the head.
Nonfatal suicidal leaps. Tn a series of re-
cent papers, l)e HaveiT"’^^ has drawn atten-
tion to some remarkable cases of suicidal
leaps from high bnildings that proved not to
be fatal. A nnmber of snch cases — in which
all data were available concerning the exact
distance of the fall, the position of the body
during the fall and on landing, and the
character of the surface that the body struck
— fc) draw certain generaliza-
tions; in tlie nonfatal lea^y the vietim gen-
erally landed flat on the back or flat on the
stomach, so that the long bones or the head
was not driven into the trunk. Bnt more
interesting is the fact that a slight degree of
cnshioning of the head, as in landing in a
garden plot instead of on a cement sidewalk,
])revented concussion and serions injnry of
other })arts. A ty2)ical case may be cited^^ :
A twenty-one-year-old woman, mentally de-
pressed because of an amorous disaj^pointment,
took a room on the tenth floor of a hotel, con-
sumed half a bottle of whiskey, and leaj)t in
her nightdress to the street below — a free fall
of 93 feet. She landed scjnarely on her back
The Journal ol the Maine Medical Association
in a small garden in which the earth had been
freshly turned, her head, back and legs sink-
ing into the earth to a depth of 4 to 6 inches.
A hand, which struck the cement border of
the garden plot, suffered a fracture to a small
bone in the wrist, bnt excej^t for this and a
fractured rib she was uninjured, suffered no
concussion, and could walk without assist-
ance. Her height was 5 feet, 7 inches, and
her weight 115 jmnnds.
The ini2)ortant 2‘>oint about this and similar
cases is that the head experienced a brief in-
terval of deceleration, instead of an abrupt
impact on a rigidly solid object. De Haven
calcnlates that the girl’s body was falling at
a rate of 73 feet a second (50 miles an hour)
at the time of the impact, and that the decel-
eration distance, which amounted to 4 to 0
inches of garden turf, must have taken place
in a small fraction of a second ; the rate of
deceleration was 106 g (1 ^ = 32 feet per
second ]:>er second). There is a vast differ-
ence between being decelerated from 50 miles
an hour in 0.001 second and being deceler-
ated in 0.1 or even in 0.01 second. Little at-
teni])t has lieen made so far to measure these
brief but vital deceleratory time intervals in
relation to injury.
A more comjDlex case occurred several
months ago in Hew York and is mentioned
l)ecanse of the relatively long distance of the
fall. A woman leajied from the seventeenth
floor, falling 144 feet, and landed in a
“steamer-chair’’ 2'»osition on a metal ventila-
tor box 24 inches wide, IS inches high and
16 feet long. The force of her fall, De Haven
points out, crushed the structure to a de}^th of
12 to 18 inches. Both arms and one lec: ex-
tended beyond the area of the ventilator, with
resultant fractures of both bones of both fore-
arms, the left humerus and the left os calcis.
The woman remembered falling and landing,
bnt had no marks on her head or subsequent
loss of consciousness. She sat up and asked to
be taken back to her room. Ho evidence of
abdominal or intrathoracic injnry was found,
and H-raj^ films failed to reveal other frac-
tTires. The minimum gravity increase in this
case was 80 g (average, 100 g).
Stunt drivers. A practical aj^plication of
the 2irinci}3le of gradual deceleration has long
been used by circus jDerformers and stunt
Nineteen Hundred and Forty-two — September
drivers, who deliberately drive a car at 60
miles an hour into a brick wall. Their trade
secret is to jump into the hack seat of the car
and lie hard against the rear of the front seat,
a hand or an ell)Ow being’ placed between the
side of the head and the hack of the front
seat. The car then crashes into a solid object
and the superstructure crumples up against
the wall, but in a finite time interval suffi-
cient to give adequate deceleration of the
head and the rest of the body. If the head or
the body were thrown without having the
l)enefit of the car’s own cruni])ling decelera-
tion, “Reckless Peter,” one of the best knowni
of these stunt drivers, could be reckless no
longer.
Aircraft®'* and automobiles, at the instiga-
tion of the Rational Safety Council, have
been studied from the point of view of dimin-
ishing hazards to the head in the event of
crash, and flying personnel are being indoc-
trinated with the principles of how to “take”
crashes. For some pilots, this is instinctive,
but the fact that the head and body should
be placed hard against some solid part of the
structure of the machine when a crash is an-
ticipated is not commonly appreciated. Any
yielding substance placed betw^een the head
and the solid area of superstructure has
cushioning value in making deceleration
more gradual ; but if the head is free and
hurled against the solid object at the time of
a crash, the injury sustained is inevitably se-
verer. Those stationed in the rear of the
automobile or plane when it strikes a solid
object have more opportunity for deceleration
than personnel situated farther forward.
Experimental concussion. Denny-Brown
and Russell®'’ have approached the problem in
the reverse direction, — namely, by analyzing
factors of acceleration in relation to injury
rather than through deceleration, — but the
principles in the two approaches are the
same. Denny-Brown and his collaborator
have found that wdien the head of an animal
is struck by a moving pendulum, concussion
does not occur unless the head is free to move,
free to be accelerated. If a head, hard against
an anvil or a brick wall, is accidentally
struck, a nasty fracture may result, but the
subject is not rendered unconscious ; for this an
acceleration of the head in space is essential.
207
In Denny-Browm’s experiments, the rate of
acceleration essential to cause concussion was
relatively high : a critical value of 46,000
feet per second per second. If the head is
cushioned, as by a helmet, the same blow may
give the same ultimate velocity after the head
has moved 5 mm., but if it does not start off
with the same high acceleration, concussion
is prevented. Tlie implications of this in re-
lation to crash helmets for absorbing blows
from falling debris and flying bomb frag-
ments are obvious, and it is no longer a secret
that both the British and the Germans have
a mandatory regulation to wear crash helmets
in all operations of mechanized units, es-
pecially motorcycles. Such helmets have
enormously diminished the number of serious
head injuries sustained on being thrown, es-
peciall}^ during Iflackout conditions.
Biipiured intervertehral disks. A syn-
drome common in the military services, es-
pecially in air-force personnel, that is not
often diagnosed is that of the ruptured inter-
vertebral disk.®^ When men are maneuvering
in aircraft, accelerations as great as 8 or 9 p'
may occur, that is, eight or nine times the
normal acceleration of gravity, wffiich cause
strains on the vertebral column of intense
character, making the weight of the torso at
the lumbosacral articulation equal to about
800 pounds if the body weight of the pilot is
200 pounds. One means of lessening the
physiological effects of high acceleration is
the assumption of a crouched posture, which
brings the lower extremities nearer the heart
and thus diminishes the leng-th of the hydro-
static column of blood subjected to accelera-
tory force.®® There is no doubt that the as-
sumption of such a posture increases toler-
ance to high degrees of acceleration, but it
also greatly increases strain on the lumbar
vertebrae, the annulus fibrosus and the pul-
posus nuclei between the vertebrae. In these
circumstances, one or more of the nuclei may
rupture and herniate into the spinal canal,
and thus may give rise to pain from compres-
sion of sensory-nerve trunks and rootlets.
This accident, which is also common in civil
life, especially in young adults, is one of the
most frequent causes of acute and incapaci-
tating sciatic pain.
208
The svndronie of the ruptured interverte-
bral disk is one with wliich every flight sur-
geon slionld he familiar, for the injury not
only occurs as a result of high acceleratio]i in
aircraft hut also is a common complication of
injuries sustained as a result of a crash land-
ing. Mild cases improve on simple immohi-
lization, Imt there is a growing conviction
among neurosurgeons, especially Spnrling,^'
of Louisville, and Love,^° of the Mayo Clinic,
that when pain is enduring even with im-
mobilization, operative removal of the rup-
tured disk is the only satisfactory therapy.
Group Captain Symonds,'‘'^ of the Royal Air
Force, reports on the British experience with
ruptured disks and expresses his doubts of
the wisdom of operation, for in his experi-
ence few, if any, eases can he returned to
active service. Spurling,^^ on tlie other hand,
reports that in his noncompensation group
fully 75 per cent have returned to their
former occupations within three months ; the
details of treatment mnst, however, he left to
the neurologist and to the neurosurgeon.
From the point of view of aviation medi-
cine, the im23ortance of the intervertebral
disk lies in the fact that one must he familiar
with the condition so as to make 2>ositive
diagnosis j^ossible, and the flight surgeon
should he interested in any 2:>rocednre or de-
vice that will lessen the incidence of this acci-
dent in combat ojierations. Various forms of
mechanical restraint, snch as seat belts and
shoulder harnesses, have been proposed to
2>revent flying j^ersonnel from l)eing thrown
or overstressed during landings and high-
S|)eed maneuvers, but there is as yet no
nnanimity of ojnnion on this jmint, and the
matter is one that clearly deserves intensive
study, not only for the }3nrpose of diminish-
ing lumbosacral injuries but also to reduce
the large numbers of unnecessary injuries to
the head sustained in conilnat maneuvers and
crash landings.
Aftermatii of Ix.tuky
The flight surgeon and other i^hysicians
who attend air-coi‘2:>s jjersonnel not only must
heed the ju’oblems of the air cadet in training
or the pilot engaged in combat o^Deration, but
he must also consider the management of in-
ca2)acitated flying 2)ersonnel. ^ome may be
The Journal of the Maine Medical Association
wounded by machine-gnin bullets, and others
may be hurt less serionsly by a crash landing
or a violent air maneuver. Still others may
deteriorate from fatigue, or from too many
missions at a high altitude. A medical ofii-
cer in charge of any command mnst be able
cpiickly to distinguish the three ty}3es of in-
cajnacity and must know how best to manage
each one — whether it is a 23lwsical injury
from gunflre, an injury from crash or maneu-
ver, or a ^psychological insult from anoxia.
AVatson-Jones^' in a recent stimulating
ipa^per, one of the few released for public con-
sumjption from the Royal Air Force, has dis-
cussed the ultimate ^problem with which all
flight surgeons vnll sooner or later be faced,
namely, the rehabilitation of personnel dis-
abled by combat ojperation. He begins his
article with a story of an injured air gunner.
An air gunner was admitted to a civilian ortho-
paedic hospital in November, 1940, for the treat-
ment of a torn and displaced semilunar cartilage.
In August, 1941, no less than ten months after ad-
mission, he was still in hospital and still totally
incapacitated. IVliy was recovery so long delayed?
What possible explanation could there be? The
diagnosis had been correctly made and a skillful
operation performed. The wound had healed by
first intention; there was no infection, arthritis,
or surgical complication. Daily massage had been
continued, but the muscles were still wasted and
pveak. Two manipulations had been performed
under anaesthesia, but movement was only half
of normal. The gait was slow and hesitant; he
limped; he could not run — he had never tried to
run. The medical officer blamed him because “he
would not cooperate,” because he was disinter-
ested, depressed, and resentful. He was certainly
depressed, for after ten months the incapacity was
more complete than on the day of admission. He
was disinterested because, in his own words, “no-
body takes any notice, and it looks as if it is hope-
less.” He was resentful because he could not be-
lieve that the fault was his. Had he not been told
that “the nerve to his knee was cut?”
He was transferred to one of the orthopaedic re-
habilitation centres of the R. A. F. Medical Service.
He saw the sky, the sea, the open spaces. For
many months he had seen only the stone walls of
hospital wards, the stone walls of massage rooms,
the stone walls of many corridors. In his new sur-
roundings there was a lounge and writing-room;
there were tasteful decorations and flowers, a
varied menu, and an atmosphere of well-being and
contentment. After a few days he smiled. There
was sometimes a sparkle in his eye. He sensed a
spirit of optimism and was reassured. His difficul-
ties were explained, and he was taught special
exercises. He learned to walk and then to run.
He became an enthusiast and worked in the gym-
nasium, played on the fields, swam in the pool,
cycled on the track. In the evenings he attended
lectures and concerts, or played billiards and
table-tennis. Time raced past, for he was busy. He
became bronzed and fit. He laughed and was full
of the joy of life. In seven weeks he returned to
his unit and to full duty. The “nerve in his knee”
was forgotten.
Nineteen Hundred and Forty-two — September
209
Ten months — total incapacity; seven weeks —
full recovery: that is the story of rehabilitation
in one air gunner. But is this an isolated case
from which no conclusion should he drawn?
We must face tlie fact tliat our air forces
will bear the sting of lieayv casualty ; cou-
valesceiit homes for study and rehabilitation
of air-force personnel must be developed on
a national scale, with a well-planned jtrogram
for analysis of injuries peculiar to tnodcrn
air combat, as well as facilities to meet the
needs — physical and spiritual — of rehabili-
tation.
Watson Jones’s recommendations concern-
ing the injured man in the air service are
essentially conventional, at least conventional
to onr nonmilitary eyes in this country. But
many military hospitals cannot study their
cases from a scientific stand] )oint, and there
may be many that would do for ten months
what was done for the air gunner of Watson-
Jones’s report. It is highly important that
the injured men from Pearl Ilarhor, Bataan,
Corregidor, Cehn, Panay, Australia, Singa-
pore, Java, India, Africa, the Mediterranean
and the Horth Atlantic sea lanes l)e given a
sense of the importance of the contribution
they have rendered, he given a sense of the
part that they may still be able to contribnte
if put back into active service. 1 am not
speaking as a psychiatrist, or even as a prac-
tical surgeon, but essentially as a layman. I
have, however, had opportunity to survey the
literature and have seen hospitals filled wifh
sick men, seriously injured men, of the fight-
ing forces of Britain ; I cannot too vigorously
emphasize the value of maintaining the
morale of the injured man, of allowing him
to take ])art in the care of others more seri-
ously incapacitated than himself, and of giv-
ing him opportunity to discuss comhat ]n-ol)-
lenis with those who have been placed before
their injury in military situations similar to
his own.
* •55-
Expansion of the air corps of l)oth the
United States ISiavy and Army has created
an unprecedented need for medical personnel.
The Uavy within the year expects to com-
plete training of more than 1,000 air medical
officers, including several hundred liight sur-
geons, and Colonel David Grant, Air Surgeon
of the Army, authorizes me to say tliaf the
Army Air Forces have now in service some
2,300 medical officers aiid that an expansion
is ex])ected within the year to bring a total of
10,000 flight surgeons and aviation medical
officers. If this demand is filled, it woidd
alone absorb all the graduates of Class A
medical schools in the United States during
the past three years.
This w'ar is probably more challenging to
the physician than any other conflict in the
world’s history. Those who serve, especially
those who serve the air forces, must have
special knowledge ; they must be cognizant of
this, cognizant also of the part that they can
|)lay in maintaining air supremacy, and of
re-estahlishing the right of free men to live
in peace.
Refeeexces
1. Osier, W. Tuberculosis pleurisy. Boston M. cf
S. ./.. 129:53-57, 81-85, 109-114, 134-138, 1893.
2. Cushing, H. Concerning diabetes insipidus
and the polyurias of hypophysial origin. Bos-
ton M. ct- 8'. ./., 168:901-910, 1913.
3. Idem. The Western Reserve and Its Medical
Traditions. 33 pp. Cleveland: Privately
printed, 1924.
4. Cannon, W. B. The physiological factors con-
cerned in surgical shock. Boston M. tf 8. •/.,
176:859-867, 1917.
5. Fulton, .1. F. Physiology and high altitude fly-
ing: with particular reference to air embolism
and the effects of acceleration. Science. 45:
207-212, 1942.
6. Hoff, E. C., and Fulton, J. F. A Bihliograplvy
of Aviation Medicine. Prepared for the Com-
mittee on Aviation Medicine, National Re-
search Council. Springfield, Illinois; Charles
C. Thomas (in press).
7. Smith, W. A. A World List of Scientific Peri-
odicals Puhlished in the Years 1 900-1 933. Sec-
ond edition. 779 pp. London: Oxford Univer-
sity Press, 1934.
8. Van Liere, E. .1. Anoxia: Its effect on the
body. 269 pp. Chicago: University of Chicago
Press, 1942.
9. Cannon, W. B. The Wisdom of the Body: Sec-
ond edition. 333 pp. New York; W. W. Nor-
ton & Co., 1939.
10. Gellhorn, E. Fundamental principles in the ad-
justment reactions of the organism to anoxia.
A7in. hit. Med., 14:1518-1532, 1941.
11. Gellhorn, E., and Lambert, E. H. The vaso-
motor system in anoxia and asphyxia. Illinois
M. cl- Dent. Monogr. 2(3):1-71, 1939.
12. Ferry, G. Les signes premonitoires de I’as-
thenie des aviateurs. Coniyt. rend. Soc. de biol.
82:637, 1919.
13. .Josue, 0. L’asthenie des aviateurs. Conipt.
rend. Soc. de biol., 82:641-643, 1919.
14. Armstrong, H. G., and Heim, ,J. W. The effect
of repeated daily exposures to anoxemia. J.
Aviation Med., 9:92-96, 1938.
210
15. Armstrong, H. G. Principles and Practice of
Aviation Medicine. 496 pp. Baltimore: Wil-
liams & Wilkins Co., 1939.
16. Sunclstroem, E. S. Studies on adaptation of
man to high altitudes. Univ. California Puhl.,
Physiol, 5:121-132, 1919.
17. Idem. The physiological effects of tropical cli-
mate. Physiol. Rev., 7:320-362, 1927.
18. Idem. Adrenal Cortex in Adaptation to Alti-
tude, Climate and Cancer. Berkeley: Univer-
sity of California Press (in press).
19. Giragossintz, G., and Sundstroem, E. S. Cor-
tico-adrenal insufficiency in rats under re-
duced pressure. Proc. Poc. Exper. Biol. cG
Med., 36:432-434, 1937.
20. Langley, L. L. The Role of the Adrenal Co?'-
tex in the Reactio?? to Lo?o At?nosphe?'ic Pres-
sure. A dissertation presented to the Faculty
of the Graduate School, Yale University, in
candidacy for the degree of Doctor of Philoso-
phy, 1942.
21. Langley, L. L., and Clarke, R. W. The role of
the adrenal cortex in the reactions to low at-
mospheric pressure. Yale J. Biol, cf Med., 14:
529-546, 1942.
22. Evans, G. The effect of low atmospheric pres-
sure on the glycogen content of the rat. A?n.
J. Physiol., 110:273-277, 1934.
23. Idem. The adrenal cortex and endogenous
carbohydrate formation. A?n. J. Physiol., 114:
297-308, 1936.
24. Lewis, R. A., Thorn, G. W., Koepf, G. F., and
Dorrance, S. S. The role of the adrenal cortex
in acute anoxia. J. Clm. I?ivestigation, 21:33-
46, 1942.
25. Thorn, G. W., .Jones, B. .J., Lewis, R. A., Koepf,
G. F., and Mitchell, E. R. The role of the
adrenal cortex in anoxia. The effect of repeat-
ed daily exposures to reduced oxygen pres-
sure. I. Experiments on rats. Am. J . Physiol.
(in press).
26. Jones, B. F., Thorn, G. W., Lewis, R. A., and
Kennedy, T. J., Jr. The role of the adrenal
cortex in anoxia. The effect of repeated daily
exposures to reduced oxygen pressure. II. Ex-
periments on rabbits. A?n. J. Physiol, (in
press) .
The Journal of the Maine Medical Association
27. Thorn, G. W., Jones, B. F., Lewis, R. A., and
Eisenberg, H. The role of the adrenal cortex
in anoxia. The effect of repeated daily expo-
sures to reduced oxygen pressure. III. Experi-
ments on dogs. A?n. J. Physiol, (in press).
28. Collip, J. B., Anderson, E. M., and Thomson,
D. L. Adrenotropic hormone of anterior pitui-
tary lobe. Lancet 2:347, 1933.
29. Uotila, U. U. The regulation of thyrotropic
function by thyroxin after pituitary stalk sec-
tion. Endocrmology, 26:129-135, 1940.
30. Idem. Hypothalamic control of anterior pitui-
tary. A. Research New. tf Ment. Dis., Proc.
(1939), 20:580-588, 1940.
31. Catchpole, H. R. Personal communication.
32. De Haven, H. Miraculous safety. Air Facts,
4:21-26, 1941.
33. Idem. Mechanical analysis of survival in falls
from heights of fifty to one hundred and fifty
feet. War Medicme (in press).
34. Committee on Aircraft Accidents. Aircraft
Accidents Method of Analysis. United States
National Advisory Committee for Aeronautics
Report No. 576. 10 pp. Washington: Govern-
ment Printing Office, 1941.
35. Denny-Brown, D., and Russell, W. R. Experi-
mental cerebral concussion. Brai?i, 64:93-164,
1941.
36. Cairns, H. Head injuries in motor-cyclists:
the importance of the crash helmet. Brit.
M. J., 2:465-471, 1941.
37. Bradford, F. K., and Spurling, R. G. The I?i-
te?'ve?'tel)ral Disc with Special Reference to
Rupture of the A?m?ilus FiWosus with Hernia-
tion of the Nucleus Pulposus. 158 pp. Spring-
field, Illinois: Charles C. Thomas, 1941.
38. Grow, M. C., and Armstrong, H. G. Fit to Fly:
A medical handbook for fliers. 387 pp. New
York: D. Appleton-Century Co., 1941.
39. Love, J. G., and Walsh, M. N. Intraspinal pro-
trusion of intervertebral disks. Arch. Surg.,
40:454-484, 1940.
40. Symonds, C. P. Sciatic pain. La?icet, 1:186,
1942.
41. Spurling, R. G. Personal communication.
42. Watson-Jones, R. Rehabilitation in the Royal
Air Force. Brit. M. J., 1:403-407, 1942.
The Platform of the American Medical Association
The American Medical Association advocates:
1. The establishment of an agency of the fed-
eral government under which shall be coordinated
and administered all medical and health functions
of the federal government exclusive of those of the
Army and Navy.
2. The allotment of such funds as the Congress
may make available to any state in actual need,
for the prevention of disease, the promotion of
health and the care of the sick on proof of such
need.
3. The principle that the care of the public
health and the provision of medical service to the
sick is primarily a local responsibility.
4. The development of a mechanism for meet-
ing the needs of expansion of preventive medical
services with local determination of needs and
local control of administration.
5. The extension of medical care for the in-
digent and the medically indigent with local de-
termination of needs and local control of adminis-
tration.
6. In the extension of medical services to all
the people, the utmost utilization of qualified med-
ical and hospital facilities already established.
7. The continued development of the private
practice of medicine, subject to such changes as
may be necessary to maintain the quality of medi-
cal services and to increase their availability.
8. Expansion of public health and medical serv-
ices consistent with the American system of
democracy.
211
Nineteen Hundred and Forty-two — September
Editorials
Industrial Health
The Officers of your Association realizing
the importance of Tndnstrial Health in tliis
war a})pointed a Special Committee on In-
dnstrial Health in February of this year with
Stephen A. Cobb, M. D., of Sanford, as
Chairman. This Committee met and organ-
ized during the annnal meeting at Poland
Spring and is now under the Chairmanship
of Joseph B. Drummond, M. D., of Portland.
Elsewhere in this issue will be found the pro-
gram of this Committee which will be a fea-
ture of the Annual Conference of Maine
Safety and Industrial Health to be held this
year at the Eastland Hotel, Portland, Maine,
on Thursday and Friday, September 17th
and 18th.
An invitation has been extended to all
members of the Association interested in In-
dustrial Health to attend this meeting, and a
request made for the names of these memljers.
Our all-out war effort cannot attain the
peak of its efficiency unless an effective ])ro-
grani for the prevention of accident and ill-
ness among industrial workers is maintained.
A large number of our industrial workers
are being shifted to new jobs and are already
working under conditions of increased stress
and strain, and called upon to operate ma-
chines to which they are unaccustomed, and
face new industrial hazards.
We must bear in mind the fact that our
armed forces are entirely dependent upon in-
dustrial j)i’od^^ction for the equipment with
which to win this war, thus the industrial
worker becomes of paramount importance to
our war effort.
It is, therefore, the task of Industrial
IMedicine to maintain Industrial Health and
so assure Industrial Efficiency.
Members in Military Service
In the County Hews and Hotes Section of
this issue of the Jourxau wc are printing a
list of the 121 members of the Maine Medical
Association now in Military Service as re-
ceived from Brig. Gen. John G. Towne,
M. C., Ret., State Chairman, Procurement
and Assignment. In addition to this list
there are 27 doctors of Maine in Military
Service who are not members of the Associa-
tion. General Towne has advised us that
there are about 36 doctors with applications
pending, and that 50 more will be needed be-
fore January to meet Maine’s quota.
We are proud of these medical men now in
Service for we know the sacrifices that they
have had to make in “^joining up.”
We are proud, too, of our medical men on
the home front, who are also making sacri-
fices, the men avIio will have to cover for those
in service, many of whom woidd like to join
their comrades in the Army or Havy but
whose duty it is to remain at home.
In succeeding issues of the Joueival will
be added the names of our members as they
take their place among the Medical Officers
of our armed forces.
Members entering military service will
help the Secretary’s office if they will send in
the address to winch they wish their copy of
the JouEXAL sent. It is hoped that the Joue-
NAL will reach each of you regularly.
212
The Journal of the Maine Medical Association
Maternal and Child Welfare
To the Members of the Maine Medical Asso-
ciation:
Your committee on Maternal and Child
Welfare, appointed after the last annual
meeting, considers that its function is to
stimulate the interest of the family physician
in prenatal care, the care of the newhorn, and
in supervision of the mental and physical
development of children.
The need for such interest is more now
than ever before. Our record in the matter
of maternal and neonatal mortality and mor-
bidity needs improving. The increased mar-
riage rate means that more obstetrics will be
done. The crowding of workers’ families in
manufacturing areas will l)ring about a need
for immunizations in children and su])er-
vision of their nutrition and mental liygiene.
With it all, there are fewer ])hysicians. There-
fore the remaining ones should interest them-
selv-es in preventive medicine, not only for
the ))nblic good, but also for their own sakes,
since ])revention is easier than CTire.
The physicians of iMaiiU' should strive to
assure every ])regnant woman that she can
and must have ])renatal carcc We must reduce
to a minimum the numbe-r of ueAvborns suf-
f(“i‘ing from birth injury because a pelvic
dispro])ortion was undiscovered, and striAT to
eliminate the tragedy of a maternal death.
Eclampsia is too fre(pient, es])ecially since
it is, Avith rai‘(' exce})tions, a preventable
disease.
Yonr committee snggc'sts that each county
society devote one of its meetings to ]u-enatal
and neonatal care. Tf any society Avishes, the
committee Avill ]>rovide s])eakers or material.
We urge that each county association stim-
ulate the interest of its oavu commnnity in
prenatal care. AVork as a group or as indi-
vidual missionaries. Granges, church socie-
ties, ]'>arent-teacher associations, legion anxil-
liaries are ex(‘ellent grou])S to start on. Tt is
easy to interest groups of Avomen in matters
pertaining to children. These groups are a
fertile field for missionary Avork in |)re.ATntiA^e
medicine. Interest the Avomeii and they Avill
form a great Aveight of public opinion to get
eATiw pregnant Avoman to a doctor’s office.
Then it is up to the doctor to giAT her an
adequate examination and so do his part to
preATiit maternal morbidity and mortality.
If the examination is casual, the patient Avill
feel that it cannot be important, and so prob-
ably Avill not come again.
In commnnities Avhere the patients are at
a distance from a doctor, and among the Ioav
income groups, the services of the visiting
nurse can be utilized. She can take blood
pressures, check on the patient’s symptoms,
and see that she sends a specimen of urine,
by mail if necessary. There are objections to
this, of course, but in these days of difficidt
travel, conditions cannot, in many instances,
be ideal. At least, the nurse’s check is better
than no check at all, and, if she recedes the
doctor’s su])port, she Avill do all she can to
get patients to the office. The Maternal and
Ghihl Health Bureau at Augusta Avill fur-
nish any physician the name and station of
the nearest visiting nurse, su})])ly ])amphlets
for distribution to patients, and help indi-
viduals or grouj)S in any possible Avay to
improAT the Avork.
Your committee pro])Oses to have artides
in the Iouuxal dealijig Avith the subjects of
maternal and child Avelfare. These Avill be
AAliolly ])ractical in nature. Conmumts and
(-riticisms Avill lie Avelcome even if they are
adATrse. AVe Avish to stir up interest. Any
memlier of the committee aaoII ansAver ijiqui-
ries or comments ])roni]Atly and Avill Awdeome
suggestions. The mendAers are Doctors A. A¥.
IhdloAvs of Bangor, chairman (res]Aonsible for
anything yon do not agree Avitli) ; G. E. Dore,
Guilford; A^irginia Hamilton, Bath; Clair
Bauman, AVaterville ; LeBoy Gross, Auburn ;
Alice AVhittier and Thomas Foster, Portland.
Let us all w(Ark togx'ther to improve the care
of mothei-s and children in ]\raine.
Your CoAi AirTTEu ox AIaterxal
AXD Crum) AVeefai^e.
Nineteen Hundred and Forty-two — September
COUNTY SOCIETIES
Androscoggin
President, Camp C. Thomas, M. D., Lewiston
Secretary, Charles W. Steele, M. D., Lewiston
Aroostook
President, Thomas G. Harvey, M. D., Mars Hill
Secretary, Clyde I. Swett, M. D., Island Falls
Cumberland
President, Roland B. Moore, M. D., Portland
Secretary, Eugene E. O’Donnell, M. D., Portland
Franklin
President, James W. Reed, M. D., Farmington
Secretary, George L. Pratt, M. D., Farmington
Hancock
President, Ralph W. Wakefield, M. D., Bar Harbor
Secretary, M. A. Torrey, M. D., Ellsworth
Kennebec
President, L. Armand Guite, M. D., Waterville
Secretary, Erederick R. Carter, M. D., Augusta
Knox
President, James Carswell, M. D., Camden
Secretary, A. J. Fuller, M. D., Pemaquid
Linco In-Sagadahoc
President, Edwin M. Fuller, Jr., M. D., Bath
Secretary, Jacob Smith, M. D., Bath
Oxford
President, Albert P. Royal, M. D., Rumford
Secretary, J. S. Sturtevant, M. D., Dlxfield
Penobscot
President, Albert W. Fellows, M. D., Bangor
Secretary, Forrest B. Ames, M. D., Bangor
Piscataquis
President, Fred J. Pritham, M. D.,
Greenville Junction
Secretary, Norman H. Nickerson, M. D., Greenville
Somerset
President, Allan J. Stinchfield, M. D., Skowhegan
Secretary, M. E. Lord, M. D., Skowhegan
Waldo
President, Lester R. Nesbitt, M. D., Bucksport
Secretary, R. L. Torrey, M. D., Searsport
Washington
President, Perley J. Mundie, M. D., Calais
Secretary, James C. Bates, M. D., Eastport
York
President, Carl E. Richards, M. D., Alfred
Secretary, C. W. Kinghorn, M. D., Kittery
213
County News and Notes
Members in Military Service'^
A ndroscoggin
Beeaker, Vincent,
Lewiston
Belivean, Bertrand A.,
Lewiston
Chevalier, Paul R.,
Lewiston
Clapperton, Gilbert,
Lewiston
Cox, William V.,
Lewiston
Frost, Robert A.,
Auburn
Greene, Merrill S. F.,
Lewiston
Mandelstam, A. W.,
Lewiston
Steele, Charles W.,
Lewiston
Tibbetts, Otis B.,
Auburn
Webber, Wedgwood P.,
Lewiston
A roosfook
Donahue, Gerald H.,
Presque Isle
Ebbett, George H.,
Houlton
Gagnon, Bernard H.,
Houlton
Labbe, Onil B.,
Van Buren
Cinnherlflud
Blaisdell, Elton R.,
Port’ and
Casey, William L.,
Portland
Christensen, Harry E.,
Portland
Clancey, Daniel J.,
Portland
Daniels, Donald H.,
Portland
Davis, Paul V.,
Bridgton
Drake, Eugene FT.,
Portland
Dunham, Carl E.,
Portland
Fagone, Francis A.,
Portland
Finks, Henry B.,
Portland
Fogg, C. Eugene,
Portland
Getcbell, Ralph A.,
Portland
Greco, Edward A.,
Portland
Ham, Joseph G.,
Portland
Heifetz, Ralph,
Portland
Holt, C. Lawrence,
Portland
Hynes, Edward A.,
So. Portland
Johnson, Albert C.,
Portland
Johnson, Gordon N.,
Portland
Laughlin, K. Alexander,
Portland
Lombard, Reginald T.,
Portland
Lothrop, Eaton S.,
Portland
Love. Robert B.,
Gorham
Marston, Paul C.,
ILezar Palls
McCrum, Philip H„
Portland
McLean, E. Allan,
Portland
McManamy, Eugene P.,
Portland
Moore, Roland B.,
Portland
Morrison, Alvin A.,
Portland
Ottuni, Alvin E.,
Portland
Phillips, Robert T.,
Portland
Poore, George C.,
Portland
Schwartz, Carol,
Portland
Simecek, Victor H.,
Brunswick
Smith, K^enneth E.,
Portland
Spencer, Jack,
Portland
Tabachnick, Henry M.,
Portland
Thompson, Milton S.,
Portland
Thompson, Philip P.,
Portland
Williams, Ralph E.,
Freeport
Franklin
Brinkman, Harry,
Farmington
Colley, Maynard B.,
Farmington
LaTourette, Kenneth A.,
Farmington
Reed, James W.,
Farmington
214
The Journal of the Maine Medical Association
Hancock
Larrabee, Charles F.,
Bar Harbor
Sumner, Charles M.,
W. Sullivan
Torrey, Marcus A.,
Ellsworth
Kennebec
Almond, Henry,
Gardiner
Bull, Frank B.,
Gardiner
Cook, Aaron,
Waterville
Fisher, Samson,
Oakland
Gingras, Napoleon J.,
Augusta
Hardy, Theodore E.,
Waterville
Hurd, Allan C.,
Gardiner
Irgens, Edwin R.,
Waterville
Lambert, Greenleaf H.,
Winthrop
Lathbury, Vincent T.,
Augusta
McLaughlin, Ivan E.,
Gardiner
McWethy, Wilson H.,
Augusta
Metzgar, John,
Augusta
Pomerleau, Rodolphe J. F.,
Waterville
Provost, Pierre E.,
Augusta
Shelton, M. Tieche,
Augusta
Towne, Charles W.,
Waterville
Towne, John G.,
Waterville
Trask, Burton W.,
Rumford
Knox
Apollonio, Howard L.,
Camden
Kazutow, John,
Bangor
Tounge, Harry G.,
Camden
Wasgatt, Wesley N.,
Rockland
Lincoln-Sagadah
oc
Lenfest, Stanley E.,
Waldoboro
Stott, Ardeune A.,
Bath
Oxford
Dixon, Walter G.,
Norway
Villa, Joseph A.,
So. Paris
Wilson, Harry M.,
Bethel
Penobscot
Clough, Herl)ert T., Jr.,
Bangor
Comeau, Wilfred J.,
Bangor
Cutler, Lawrence M.,
Bangor
Emery, Clarence, Jr.,
Bangor
Feeley, J. Roljert,
Bangor
Gregory, I. Francis,
Bangor
Hinman, Havilah E.,
Orono
Houlihan, John S.,
Bangor
Pressey, Harold E.,
Bangor
Shapero, Benjamin L.,
Bangor
Witte, Max E., Jr.,
Bangor
Piscataquis
Curtis, John B.,
Milo
Marsh, Burton S.,
Greenville Jet.
Nickerson, Norman H.,
Greenville
Thomas, William B. S.,
Dover-Foxcroft
Somerset
Laney, Richard P.,
Skowhegan
Stinchfield, Allan,
Skowhegan
Waldo
Jones, Richard P.,
Nesbitt, Lester R.,
Belfast
Bucksport
Washington
Cobb, Norman E.,
Knapp, Allan H.,
Metcalf, John,
Calais
Macbias
Machias
York
Cobb, Stephen A.,
Downing, J. Robert,
Gould, George I.,
Hill, Paul S., Jr.,
Kendall, Clarence P.,
Murphy, John J.,
Myer, John C.,
Richards, Carl E.,
Tower, Elmer M.,
Sanford
Kennebunk
Biddeford
Saco
Biddeford
Wells Beach
No. Berwick
Alfred
Ogunquit
* As we do not have a record of the assig-nmcm and
rank of all these members we are printing only their
names and home addresses.
Franklin
The Franklin County Medical Society held its
regular Summer meeting together with the Staff of
the Franklin County Memorial Hospital at Voter
Hill Farm, Farmington, Sunday, August 9, 1942.
Forty-six members and guests were present.
Dr. Carl H. Stevens, President of the Maine
Medical Association, accompanied by Mrs. Stevens,
was present, and discussed matters of importance
to the Association.
Drs. Harry Brinkman, James Reed and Maynard
Colley, of Farmington, were present in uniform.
All three expect to leave soon for Service in the
Army.
Dr. Frank Springer is awaiting orders for serv-
ice in the Navy, and Dr. Kenneth La Tourette is
now serving with the Air Corps.
Dr. C. C. Weymouth and Dr. H. S. Pratt showed
some very interesting motion pictures.
George L. Pratt,
Secretary.
For Sale
2 Instrument Cabinets, 3 Filing Cabinets, 3 In-
strument Tables, 2 Sterilizers, and a variety of
general surgical instruments. Can be bought very
reasonably.
For Rent
Five Suites of Offices: Two furnished: Three
unfurnished. Receptionist in attendance.
Mrs. William D. Anderson,
29 Peering Street,
Portland, Maine,
Telephone 2-5222.
Nineteen Hundred and Forty-two — September
215
INDUSTRIAL HEALTH
Maine Safety and Industrial Health Conference
EASTLAND HOTEL
Thursday and Friday, September 17th and 18th, 1942
Department of Labor, State of Maine
Maine Medical Association
FRIDAY. SEPTEMBER 18. 1942
10.00
Industrial Health Program conducted by the Spe-
cial Committee on Industrial Health of the
Maine Medical Association, Joseph B. Drum-
mond, M. D., Portland, Chairman.
Remarks by Carl H. Stevens, M. D., Belfast, Presi-
dent of the Maine Medical Association.
First Aid, Its Rehabilitation in Head Injuries,
H. Eugene Macdonald, M, D., Portland
Communicable Diseases in Industry,
Roscoe L. Mitchell, M. D., Augusta,
Director, State of Maine Department
of Health and Welfare
A. M.
First Aid in Injuries,
Allan Woodcock, M. D., Bangor
Industrial Nursing,
Mrs. Merle R. Lord, R. N., Sanford,
President, Maine Branch of Indus-
trial Nurses
Occupational Diseases,
Edwin M. Fuller, M. D., Bath
Prevention and First Aid Treatment of Eye
Injuries,
E. Eugene Holt, M. D., Portland
To the Memhers of the Maine Medical Assoeiation :
The Special Committee on Industrial Health of
the Maine Medical Association invites all members
of the Association interested in Industrial Health
to attend this meeting.
Joseph B. Drummond, M. D., Portland,
Chairman,
Indnstrial Health Committee.
To County Secretaries :
The Special Committee on Industrial Health of
the Maine Medical Association earnestly requests
the County Secretaries to send a list of all mem-
bers interested in Industrial Health, also a list of
Industrial Plants which maintain First Aid Sta-
tions under the supervision of an Industrial Phy-
sician 01’ nurse to;
Jo.sepii B. Drummond, M. D.,
Chairman,
Industrial Health Committee,
62 State Street,
Portland, Maine.
Notice
Annual Meeting of the Maine
Medico-Legal Society
The Maine Medico-Legal Society held its Annual
Meeting at Poland Spring, Tuesday, June 23rd,
with William Holt, M. D., of Portland, President,
presiding. Legal angles were discussed by Former
Attorney-General Franz U. Burkett, Attorney-Gen-
eral Frank I. Cowan, Chief Henry P. Weaver, of
the Maine State Police, County Attorney Albert
Knudsen, Portland, County Attorney Benjamin
Butler, Farmington, and County Attorney Theo-
dore Gonya, Rumford.
An interesting paper on Coronary Occlusion, its
Legal Aspects, was presented by Joseph E. Porter,
M. D., Associate Pathologist of the Maine General
Hospital, and William Holt, M. D.
The guest speaker was Alan R. Moritz, M. D.,
Professor of Legal Medicine of Harvard University,
who gave an excellent talk on “Forensic Pathol-
ogy,” illustrated with extremely interesting slides.
Motions were passed authorizing the Executive
Committee to act for the Society, in case any legis-
lative activity is undertaken.
Governor Sumner Sewall, Henry P. Weaver, and
Alan R. Moritz, were elected to honorary member-
ship.
Officers for the ensuing year were elected as
follows:
President — Albert Knudsen, Portland.
Vice President — D. M. Stewart, M. D., South
Paris.
Treasurer — W. S. Stinchfield, M. D., Skowhegan.
Secretary — George L. Pratt, M. D., Farmington.
George L. Pratt,
Secretary.
216
The Journal of the Maine Medical Association
PfioceeaUuf^.
NINETIETH ANNUAL SESSION
Maine Memcai /laociaiion
POLAND SPRING, MAINE
JUNE 21, 22, 23, 1942
FIRST MEETING OF THE HOUSE OF
DELE(JATES, JUNE 21, 1942
The first meeting of the House of Delegates of
the Maine Medical Association convened at the
Poland Spring House, Poland Spring, Maine, on
Sunday, June 21, 1942, at 4.50 o’clock in the after-
noon, with Dr. Carl H. Stevens of Belfast, Presi-
dent-elect of the Maine Medical Association, pre-
siding.
Cii-ViRMAN Stevexs; The meeting will please
come to order. Our Secretary, Dr. Frederick R.
Carter of Augusta, will now call the roll.
(Secretary Carter then called the roll and the
following delegates responded : )
Androscoggin: — Horace L. Gauvreau, M. D.,
liCwiston. Alternates: William H. Chaffers, M. D.,
Lewiston: Albert W. Plummer, M. D., Lisbon
Falls.
Cumberland: — Thomas A. Foster, M. D., Port-
land; Frank A. Smith, M. D., Westljrook; DeFor-
est Weeks, M. D., Portland; Elton R. Blaisdell,
M. D., Portland; Philip H. McCrum, M. D., Port-
land; Clyde E. Richardson, M. D., Brunswick;
Richard S. Hawkes, M. D., Portland.
Franklin: — George L. Pratt, M. D., Farmington.
Hancock: — Raymond E. Weymouth, M. 1)., Bar
Harbor.
Kennebec: — Ivan E. McLaughlin, M. D., Gar-
diner; Frank B. Bull, M. D., Gardiner.
Knox: — C. Harold Jameson, M. D., Rockland.
Alternate: James Carswell, M. D., Camden.
Lincoln-Sagadahoc: — Virginia C. Hamilton, M.
D., Bath.
Oxford: — Roswell E. Hubbard, M. D., Water-
ford: Dexter E. Elsemore, M. D., Dixfield.
Penobscot: — Forrest B. Ames, M. D., Bangor;
Ernest T. Young, M. D., Millinocket.
Piscataquis: — Harvey C. Bundy, M. D„ Milo.
Waldo: — Raymond L. Torrey, M. D., Searsport.
York: — Edward M. Cook, M. D., York Harlmr;
Waldron L. Morse, M. D., Springvale. Alternate:
Carl E. Richards, M. D., Alfred.
CiiAiKMAN Stevens: The next order of busi-
ness is the appointment of a Reference Committee
by the Chair. I appoint Dr. Thomas A. Foster of
Portland as Chairman, Dr. George L. Pratt of
Farmington, and Dr. Forrest B. Ames of Bangor*,
members of the Committee.
The next order of business is the appointment
of a Nominating Committee.
For the First District I appoint Frank A. Smith
of Westbrook; Second District, Merrill S. F.
Greene of Lewiston; Third District, C. Harold
Jameson of Rockland, who will act as Chairman;
Fourth District, Raymond L. Torrey; Fifth Dis-
trict, Raymond E. Weymouth of Bar Harbor;
Sixth District, Harvey C. Bundy of Milo. This
Committee is to draw up a slate of Standing Com-
mittees for 1942-1943 and report their delibera-
tions to the second meeting of the House of Dele-
gates tomorrow, June 22nd, at 5.30 P. M.
We are now ready for the report of the Council
for 1941-1942, by Dr. Stephen A. Cobb of Sanford,
Chairman.
( Dr. Cobl) then read his prepared report of
Council Meetings held at York Harbor, June 24,
1941; Greenville, July 24, 1941; Portland, October
IG, 1941; Augusta, April 16, 1942; Poland Spring,
June 21, 1942, and of Council Business transacted
by mail. This report is on file in the Association
Office at Portland. )
Chairman Stevens: The Chair awaits your ac-
tion concerning the report of the Council, as sub-
mitted by Dr. Cobb.
Dr. Thomas A. Foster of Portland: Mr. Chair-
man, I move the acceptance of this report, and in
moving its acceptance, I would like to submit for
the record the fact that the Councilors attended
the meetings one hundred per cent, and that the
Scientific Committee attended the meetings one
hundred per cent. I think that is an excellent
example for the Association to follow. I think the
fact of having that on the record may be of some
value to future Councilors and future executive
committees.
Dr. George L. Pratt of Farmington: I will
second that motion.
Chairman Stevens: It has been moved and
duly seconded, that the report of the Council be
accepted. Those in favor of this motion will please
signify by a showing of hands. Those opposed
by the same sign.
There teas a chorus of “ayes” and the motion
was carried.
Chairman Stevens: Two motions are now pre-
sented.
1. I move that the Council be instructed to
appoint a Committee from the Maine Medical
Association to follow out the suggestions made in
the letter from Frank Mott to Frederick R. Carter,
Secretary, regarding the expenditure of $20,000
left under the will of Amy W. Pinkham for the
use of tuberculous and under-nourished children
of Maine.
(The letter from Mr. Mott to Dr. Carter was
read by the Chairman of the Council, Dr. Cobb,
and is on file in the Association Office at Portland.)
The Chair awaits your action. This motion is
presented by Dr. Norman H. Nickerson of Green-
ville.
Dr. Pratt: I will second Dr. Nickerson’s mo-
tion, and 1 wish to move that this matter be sent
to the Reference Committee tor their considera-
tion and report back to the next meeting of the
Mouse of Delegates.
This motion was duly seconded and was carried.
Chairman Stevens: A second motion present-
ed by Dr. Nickerson is as follows:
I move that the Association express its opinion
to the Governor and Legislative bodies that the
supervision oi the distribution of milk in Maine
should be under the Department of Health rather
than under the Department of Agriculture.
The Chair awaits your action on Dr. Nickerson’s
motion.
Dr. Pratt: I will second that motion, and
move further that this matter be sent to the Ref-
* Dr. Bine.st T. Young', of Millinocket, was appointed a meinbei' of the Reference Committee in place of Di.
Ames, who had to return to Bangor immediately following this meeting.
217
Nineteen Hundred and Forty-two — September
orence Committee for their consideration, report-
ing back to onr next meeting.
Upon a hand vote, this motion was carried.
Chairman Stevens: The next order of busi-
ness is the presentation of the 1942-194-3 budget,
as recommended by the Council.
President P. L. B. Ebbett of Hoiilton: There
is one other suggestion there which I think I
presented to the Council myself. It is something
that I am rather interested in, personally, because
it would be of great benefit to our Association. It
was that the Council approve that we elect Her-
bert E. Locke to honorary membership in our
association.
Now. this may be assuming something of a
precedent, but it has been done in other societies
and can be done in ours. Until you are intimately
associated with the affairs of the Association, you
just cannot realize what a lot of work Mr. Locke
puts in for us. Last winter, he spent days, and
his time even went into weeks, trying to get
some legislation through for us, for which he
wasn’t receiving much of anything. He was doing
it, you might say, gratis; his remuneration was so
slight it wouldn’t have covered hardly his ex-
penses, let alone other efforts put into it.
I can say that he is a very valuable man to us,
not only in legislative work, but also in our
medico-legal work, and I do feel that it would be
merely showing our appreciation if we should con-
fer this honor upon him, and I know that he
would appreciate it, and also that perhaps he
might be still more active in our interests, al-
though I don’t know how that would be possible
because all winter long when certain matters are
coming up, he will come to us with them and say:
“Is there anything I can do for you?” Now, he
wasn’t getting anything for that. But he was
taking an interest in our Association, and our
welfare, and I really feel that it would be a nice
gesture on our part, if we can see our way clear
to electing this man to honorary membership.
I should like to make that motion, that we elect
Herbert E. Locke to honorary membership in the
Maine Medical Association.
Dr. Frank H. Jackson of Houlton: I am not
a member of the House of Delegates but I would
like to say this. For quite a number of years, I
have been intimately associated with Mr. Locke on
your Medical Defense Committee. I don’t know
how a man could be any more loyal and efficient
in that job than he has been.
Of course, it is not my privilege and I wouldn’t
assume it, to speak of the work of that Committee.
That is only reported to the Council, for the rec-
ords of this Association, but I would say this.
We have had an enormous amount of work to do
in the last few years. This year, we did not meet,
as we usually do, with Dr. Robinson in Portland,
but Mr. Locke had a great deal of correspondence
individually with the members, and certain impor-
tant cases came up and he came personally to see
members who were interested in and who could
handle those cases, as he felt, to the best advan-
tage of the Association as well as to the man
whose safety was jeopardized.
I want to say this, if I may, that I think it
would be a most gracious thing if this House of
Delegates would vote unanimously to afford this
honor to Dr. Locke.
Dr. Edward M. Cook of York Harbor: I would
like to second the motion of Dr. Ebbett, that Her-
bert Locke be made an honorary member of this
Association.
Dr. Frank A. Smith of Westbrook: Do the by-
laws have to be altered for this, Mr. Chairman?
Chairman Stevens: I don’t think so. As far
as I know, they would not. The by-laws state, con-
cerning the members who have been in practice
fifty years, that they are eligible for honorary
membership.
Is there any further discussion? If not, those
in favor of the motion will please signify by the
usual sign?
The motion was unanimously carried, by a hand
vote.
Chair:man Stevens: The next order of busi-
ness is the presentation of the 1942-1943 budget,
as recommended by the Council, and this will be
given to you by Dr. Cobb, Chairman.
Dr. Cobb: The budget for 1942-1943 includes
the following items:
President’s expenses: (Expended this past year,
$300). Recommended, $300.
Salaries: For Secretary-Treasurer ($1200 ex-
pended). Recommended, $1200.
Salaries: Assistant Secretary ($1,500 expended).
Recommended, $1500.
Office expenses: Secretary-Treasurer and Port-
land office ( expended during the past year,
$1112.72). Recommended, $1150.
Committees: Medical Advisory Committee (the
budget last year was $650, and there was expended
$515.67). Recommended, $650.
Committee on Graduate Education (the budget
was $300 last year, expended $59.62). Recom-
mended, $100.
For other Committees (the budget was $100, ex-
pended, nothing). Recommended, $100.
State Delegates and Council (the budget was
$200. There was expended, $99.86). Recommend-
ed, $200.
Delegate to the American Medical Association
Annual Session (the budget was $150. There was
expended $91.75). Recommended, $250. (The rea-
son for that, of course, is that the next annual ses-
sion is at San Francisco.)
Annual Session (the budget was $100. Nothing
was expended ) . Recommended, $100.00.
For the Fall Clinical Session (the budget was
$250, and the amount expended was $37.10). The
amount recommended was nothing, because it was
recommended to the Council that due to war con-
ditions, in our opinion it would not be advisable
to hold a clinical session this year.
Appropriation to the Johrnal expenses:
Salary of the Editor (expended, $1,000). $1,000
is recommended.
Joi'RNAL expenses not covered by advertising
(in the budget last year, this amount was $750
Expended, $370.69). Recommended, $750.
The total, last year, of the budget, was $7,650.00.
expended, $6,286.81. Recommended this year,
$7,300.
CiiAiRJiAN Stevens: You have heard the report
of the Budget for 1942-1943, submitted by Dr.
Cobb. The Chair awaits your action.
Dr. Ebbett: I move that the Budget be ac-
cepted as read, as a whole.
This motion was duly seconded and Avas carried.
Chairman Stevens: The next order of busi-
ness is the report of Delegates. The first report
we are going to hear is that of the Delegate to the
American Medical Association Annual Meeting,
just held, by Dr. Thomas A. Foster.
Dr. Foster: Mr. President and members of the
House of Delegates;
At the 89th Meeting held in York Harbor, June,
1941, the House of Delegates elected Doctor
William Ellingwood of Rockland, a Delegate from
our association to the House of Delegates of the
American Medical Association. Dr. Ellingwood
had served faithfully for many years as our dele-
gate to the National House and was appropriately
re-elected for a term of two years. We all realized
last June that Dr. Ellingwood was fighting with a
218
gallant spirit a malady which was unconquerable.
And in the Autumn of 1941, he was called to his
final rest. I would like at this time to pay a tribute
to his devotion and loyalty to this association and
to the House of Delegates, of which he was a
beloved member for many years.
As your alternate delegate, I arrived in Atlantic
City, June 7th, and reported for the first Session
of the House Monday morning at 8.30 A. M. in
the Hotel Traymore.
A year or more ago, the Council on Scientific
Assembly, together with the Officers of the
A. M. A., made plans to have the 1942 meeting'
feature a Pan-American Session. The House of
Delegates approved the recommendation at their
meeting at Cleveland in 1941, and it was the hope
of the Council to have present at the session in
Atlantic City a large number of the physicians of
South and Central America, Mexico, and Canada,
but, “greatly to the regret of the Council and to
the officers and members of the A. M. A., condi-
tions created by the war have made it impossible
to carry out this original plan.” However, several
distinguished physicians from Southern countries,
from Mexico and Canada accepted invitations to
participate in the scientific work of the associa-
tion and appeared before the General Scientific
meeting and in the meetings of the Sections. The
war had its effect on this meeting in other ways.
But it was a fine and well attended gathering.
First, a Report on the Proceedings of the House:
The Roll Call revealed a majority, delegates
from Alaska, Hawaii, Isthmian Canal Zone, and
Philippines the only ones not present, and Dr.
H. H. Shoulders, Speaker of the House, started
the proceedings. One of the first acts was to
select from three candidates presented by the
Board of Trustees, a recipient for the Distin-
guished Service Medal awarded each year. The
candidates were Elliott P. Joslin, Ludgvig Hektoen
and George Crile. On the first ballot, no choice
was manifested. Much to my surprise, Joslin was
the low man and was dropped. On the second
ballot. Dr. Hektoen was chosen to receive the
award. Dr. Hektoen is professor emeritus of
Pathology at Rush and was professor and head
of the Department of Pathology from 1901-1932
at the University of Chicago.
Following this election came the addresses of
the Speaker of the House, Dr. H. H. Shoulders,
President Frank H. Lahey, and President-elect
Fred W. Rankin. These are printed in the July
11th issue of The Journal of the American Medi-
cal Association. They are short, right to the point,
and give an up-to-the-minute declaration of the
position of your association. Then came reports of
the Secretary and Treasurer, Chairman of the
Board of Trustees, and the presentation of Resolu-
tions. The Secretary reported a membership of
120,701 on April 1, 1942, compared to 118,441 on cor-
responding date in 1941. The Board of Trustees
reported a Gross Income from all sources for the
year of $1,939,127.39, an increase over preceding
year of $62,773.59. Net income for 1941, after
appropriating $215,000.00 for a new storage build-
ing, amounted to $223,374.64, of which $77,424.09
represents interest on investments.
(Maine on the official Record has Fellows 361, —
165 Subscribers, a total of 526 who receive the
Journal of the A.M.A.) The Reports of the work
of the various Councils need not take time here,
except to say that they are active and progressive
Councils. The Treasurer reported Invested and
Universal Funds as of December 31, 1941,
$2,708,661.11.
The Auditors’ Report stated that the attorneys
The Journal of the Maine Medical Association
reported that the following law suits against the
association were on file:
Jean Paul Fenel, 1 Million (libel),
Wm. E. Balsinger, $100,000.00 (libel),
Muriel Langine, $1,000.00 (claim).
United States of America (conspiracy in
restraint of trade),
and adds, “in their opinion, all of these suits will
be defeated.”
After an all-day session, the House adjourned
to allow for Reference Committee Meetings, which
were held at the Hotel Traymore in various and
sundry rooms.
The Medical Society of New Jersey and The
Medical Society of Atlantic County gave a dinner
in honor of the Delegates following the session
of Monday. It was a jolly party and excellent
dinner. Mr. Paul McNutt spoke after dinner and
spoke in no uncertain language. He stated that
the doctors were the only group who were allowed
to formulate their own plan for furnishing officers
for the army, and that he hoped that the plan was
going to work. But if it didn’t deliver 5000 M. D.’s
by the first of July, some other plan would be set
in operation, and he didn’t mean maybe. The
next morning in the House of Delegates he re-
peated his remarks with somewhat softer music,
but he sounded a serious note. Dr. Dahey, later
in the day, reported that he thought the 5000
would be secured, but that the doctors must be
prepared to furnish 40,000 more officers, if the
present Army and Navy plans are developed. And
he thought that the “Procurement and Assign-
ment” could do the job.
The larger amount of the time of the Delegates
from this period was devoted to consideration of
the reports of the Resolutions coming from the
Reference Committees. To discuss all these re-
ports would be all too time-consuming, but to
report to you on the controversial ones is the
duty of your delegate.
The first one to arouse discussion was a proposal
to increase the number of Trustees from nine to
eleven. This was sponsored by California, sup-
ported by Texas and other western states. The
Committee report was opposed to the increase,
and, on a vote of the House, the report was
adopted. So the Trustees remain at nine.
The next resolution, which divided the House,
was the proposal of the Wisconsin Delegates to
approve and endorse the National Physicians
Committee for Extension of Medical Service. This
measure had both strong support and strong oppo-
sition. But everyone who spoke paid a compli-
ment to the work of the Committee and urged its
continuance. The opposition felt that it was
dangerous strategy for the A. M. A. to endorse any
special Committee doing propaganda work, which
might entail lobbying and politics. The Supporters
argued that the Committee was doing valuable
work, which must be continued, and that the
A. M. A. should endorse it. The Committee brought
in a majority and minority report; the majority
report lauded the work of the Committee, but
recommended a compromise support by not nam-
ing the Committee and endorsing all agencies
which helped to enlighten the public favorably
toward medicine. The minority report came out
fiat-footed for the endorsement of the N. P. C.
The minority report prevailed. And the A. M. A.,
through its House of Delegates, has confirmed
and endorsed the N. P. C., which wants and needs
the support of every individual member.
Another report which called for discussion was
the Proposal of Dr. Emily D. Barringer of the
New York Delegation, and lone woman delegate.
She asked for the support of the association in
Nineteen Hundred and Forty- two — September
securing commissions for women doctors in the
Armed Forces of the U. S. A. Dr. Barringer spoke
well for the proposal and gained support for it.
But the Committee report was against its adoption,
and on a rising vote, the report was adopted. So
the A. M. A. went on record at this time as opposed
to asking the Surgeon General of Army, Navy, and
Public Health Department to commission women
physicians.
The last Resolution, which caused much debate,
was the Proposal of the Massachusetts Delegation
for the Formation of prepayment Medical Plans
for Low Income Groups “at the behest of the A.
M. A.” The association officers and Committee
Chairmen believed that such plans should be helped
by all the means at the disposal of the A. M. A.,
but should originate in County and State Societies,
and the resolution so worded was approved. Other
resolutions, such as one to dissuade Hospitals
from collecting for Medical Services without a
statement from the attending physician, and one
deploring and disapproving the issuance of Health
Certificates or “clean bill of health” to prosti-
tutes, and one against rebates or commissions
from Drug Houses were passed. Then, in the final
session, came the election of officers and selec-
tion of a meeting place for 1945.
First, the election of Dr. James Edgar Paullin
as President-Elect was unanimous; next. Dr.
William Carrington, Atlantic City, Vice-President;
and Dr. West and Dr. Kretchner, Secretary and
Treasurer. Dr. Paullin is from Atlanta, Georgia.
He was Chairman of the Council on Scientific
Assembly.
He was graduated from Mercer University in
1900 and Johns Hopkins Medical School in 1905.
At one time was resident Pathologist at Rhode
Island Hospital in Providence. He was a Major
in the Medical Corps of the Army, 1918-1919, and
is retiring President of American College of
Physicians and is a Member of the Procurement
and Assignment Committee.
Next, the election of two Trustees, the first to
succeed Dr. Arthur W. Booth of Elmira, New
York, who had served two terms of five years. A
contest developed between Dr. Gordon Heyd of
New York and Dr. Edward M. Pallette of Los
Angeles. Dr. Pallette was the successful candi-
date, and the election was made unanimous upon
motion of Dr. McGouldrick of New York.
The second was a re-election — Dr. R. L. Sen-
senich, of South Bend, Indiana.
And finally, selection of a Meeting Place for
1945. Atlantic City and New York both invited
the A. M. A. Meeting. New York was selected by
a fairly large vote.
Now for a short report on the General Assembly.
Total Registration was 8,103 for four days. Prom
Maine, twenty-two members registered, not a
large delegation.
The technical exhibitions, which numbered over
250, were up to standard. In one, arranged by
Mead-Johnson Company, were exhibited works of
art contributed by Physicians. It was a pleasure
to find here a painting by one of our Members,
Dr. John Allen, and particularly pleasing to see
that the painting had won an Award.
The Scientific Assembly featured this year ses-
sions for the General Practitioner and for Medical
Examiners. These Sessions under the Section on
Miscellaneous Topics were among the most pop-
ular, between four and five hundred registering.
The Scientific Exhibitions beggar description.
All Sections had numerous and varied demon-
strations. Your delegate enjoyed particularly the
demonstration of the Kenney treatment of Ant.
poliomyelitis on living models. There were demon-
strations to interest each and every visitor. Dr.
Hirsh Sulkowitch, of Portland, showed an exhibit
with Dr. Puller Allbright and others.
It seems to me inappropriate in rendering this
report not to express my thanks to you for elect-
ing me to this honorable position. I do appreciate
it, and I urge all of you to consider seriously the
opportunities which exist for continuing Medical
education at these unequalled annual meetings of
the A. M. A. This year, in addition to the best
talent in the United States, came added talent
from South America, Mexico, Cuba, Puerto Rico,
and Canada. Gentlemen, it is a great show; plan
to go and see for yourselves.
Chairman Stkvens: Thank you. Dr. Foster, for
the fine and comprehensive report you have given
to us.
The Chair awaits your pleasure as to the accept-
ance of this report.
Dr. C. Harold Jameson of Rockland: I move
the acceptance of the report of Dr. Poster as
Delegate to the American Medical Association
meeting held at Atlantic City.
This motion was duly seconded by several of the
members present, and was carried.
Continued in the October Issue
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Hospital Pharmacy, Inc XIII
Hynson, Westcott & Dunning, Inc XIV
Jones’ Private Sanitarium VI
Leighton’s Hospital, Dr VI
Lilly & Company, Eli XII
Marks Printing House XIII
Mead Johnson & Company XVII
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Parke, Davis 8l Company IX
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Philip Morris & Co VIII
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The Journal
of the
Maine Medical Association
Uolume Thirtij^three Portland, Uldine, October, 1942 No. 10
Medical Queries Answered"^
Spnposiiim Conducted l)y Samuel H. Peogee, M. D., William B. Dameshek, M. D,,
Haeold E. MacMahon, M. D.
Edited bv J. Gottlieb M. D,
t- '
QUESTTOE : Mlmt is the prese7it status
of erytlieyna nodosum, etiology and treat-
ment ?
ANSWER :
De. MacMaiio y : This is a non-specific
grannloinatons inflainmatoiy reaction that
tends to occur in the subcutaneous tissues in
a number of separate and distinct clinical en-
tities. Eor example: Rheumatic fever, tuber-
culosis, coccidiomycosis and streptococcus
infections. It is possible that a state of hyper-
sensitivity is the common denominator of
those diseases in which it is found.
QUESTION : Discuss the diet in the pre-
operative management of a patient ivith
cholecystitis and cholelithiasis and moderate
icterus.
ANSWERS ;
De. Dameshek : The patient has evi-
dently been through a severe attack, prob-
ably associated with vomiting and fever and
* From the Central Maine General Hospital Teaching
December 19
the chances are he has become depleted of
fluids, chlorides, and vitamins. Fluids may
be given either subcutaneously or intraven-
ously in the form of normal saline and glu-
cose. The liver may well have been damaged
during the process so that it may be advisable
to give large amounts of glucose intraven-
ously and orally. Vitamin “C” deficiency
often develops so that either orange juice or
ascorbic acid by mouth is helpful in facilitat-
ing wound healing. Due to obstruction to the
flow of bile. Vitamin “K” deficiency and
hypoprothrombinemia develop. Vitamin ‘Ti”
either orally or intramuscularly should there-
fore be given. The diet should be very light,
low in fat, high in carbohydrates, probably
low in protein.
De. Fullee : How about eggs in this diet ?
De. Dameshek : I would keep away from
eggs. They will contract the gall bladder.
This prescription applies equally to all fatty
foods, including eggs.
Clinic, Bingham Hospital Extension Service,
1941.
222
The Journal ol the Maine Medical Association
QUESTIOjN" ; Discuss present etiology
and treatment of peptic idcer.
ANSWERS :
Dr, Peoger : As to etiology, there are
only a few things that need be said. In the
first place, there is no knowledg’e as to defi-
nite etiology. They occur only in those parts
of the gastrointestinal tract where the mncosa
conies in contact with acid secretions. This
indicates that the acid must he an important
factor in the etiology. A corollary to this fact
is that anything which neutralizes the acid
tends to relieve the pain from the ulcer and
bring the ulcer under control. As to the treat-
ment of peptic ulcer a few points may be
mentioned. In the first place the use of col-
loidal aluminum preparations, such as Am-
phojel or Creamalin has done much to elimi-
nate the ill-effects sometimes resulting from
the use of alkalies while at the same time the
good effects of the alkalies, namely the neu-
tralizing effects, have been retained. Except
for its occasional constipating effect, the long-
continued use of colloidal aluminum prepara-
tions is probably harmless despite some ex-
perimental evidence which indicates that
there may be a mal-absorption of inorganic
phosphates as a result of aluniinnm hydrox-
ide therapy. With colloidal aluminum prepa-
rations it seems to me that the more extreme
dietary measures such as hourly milk and
cream feedings, are not entirely necessary ;
that is to say, even acute ulcers often do quite
well on a so-called second or third stage
Sippy diet if sufficient colloidal aluminum is
used between feedings.
Treatment of peptic ulcer raises the ques-
tion of surgery. The indications for surgery
remain as previously. The surgical methods,
however, fortunately have been changed so
that the relatively unsatisfactory gastro-en-
terostomy is rarely done now but has been re-
placed by the much more satisfactory, so far
as end-results are concerned, subtotal gastrec-
tomy. In a consideration of which patient
should be operated it is well to remember that
ulcers of the stomach which are large, in the
pre-pyloric region, on the greater curvature,
or which recur despite good medical treat-
ment, should be suspected of being malig-
nant and should be operated. The fact that
a lesion seems to clear up and that the stools
become negative does not eliminate the possi-
bility of malignancy. Small gastric ulcers and
those on the posterior wall also may be malig-
nant and should be carefully observed with
this in mind. The questionably malignant
cases should have resections done.
As to the medical treatment of bleeding
peptic ulcer there is still considerable contro-
versy although most gastroenterologists feel
that the Meulengracht diet, which is a very
liberal diet, including meat, may be given
with safety at tlie outset. Whether such a
diet is actually preferable to extreme dietary
limitation with adequate management of
fluid balance during the early stages of Ifleed-
iiig from a peptic ulcer, remains to be deter-
mined.
Dr. Dameshek : I should like to raise the
question of the importance of emotional fac-
tors.
Dr, Proger : That is also important, as it
is in almost any organic disease and I should
have brought that uj:), too. The nervous fac-
tor is most important. In this connection, it
is of interest that the incidence of peptic
ulcers in the fighting forces in England dur-
ing the j:)resent war is highest in the army,
less high in the navy and least high in the air
force. This has been attributed to the fact
that there is more purposeful activity in the
air force, relatively less in the navy and least
in the army. Tension without purposeful ac-
tivity seems therefore to be a factor in pre-
cipitating ulcers.
QUESTION : Is intercapUlanj glomeru-
lar sclerosis accepted f
ANSWERS :
Dr. MacMaiiox : Clinically there appears
to be an entity characterized by hypertension,
anasarca, hypoproteinaemia, cholesteraemia
and albuminuria; combined with diabetes.
Grossly there is nothing characteristic in the
kidney that would enable one to make this
diagnosis. On histological examination, a le-
sion has been described in the glomeruli, — a
severe atherosclerosis involving the capillaries
and their associated basement membranes.
This histological lesion has been described as
intercapillary glomerulosclerosis. Now the
interesting thing is that this histological le-
223
Nineteen Hundred and Forty-two — October
sioii is not common and when it occurs it is
seldom diffuse throngiiout either kidney, and
it may or may not be found together with the
clinical entity. I have seen it very, very
rarely as a histological entity, and in none of
the cases that have come to my attention, has
the clinical entity been apparent.
Dr. Progeb: We have discovered three or
four patients who had diabetes and nephritis
and edema and hyjjertension, and Dr. Law-
rence of Enmford will recollect that we saw
one patient in Rnmford — a twenty-year-old
with diabetes and nephritis who might have
been suffering from this disease, hut it must
remain for the pathologist to establish the
final diagnosis.
QUESTION : MHiat is the danger, if any,
in determining a glucose tolerance curve in a
patient ivith a hlood sugar of 225 mgs. %f
ANSWEK :
Dr. Dameshek: One doesn’t like to over-
load a patient with a hlood sugar so high. It
might easily make the diabetic problem much
worse. In the case of a mild or questionable
diabetic, it is perfectly all right to do a glu-
cose tolerance test.
QUESTION : What are the limitations of
fluid and salt intahe in the treatment of car-
diac failure?
x\NSWER:
Dr. Proger : I do not believe the fluid re-
striction is so important in the treatment of
heart failure if the salt intake is restricted.
In order for fluid to be retained sodium
chloride must be available and retained.
There can be no salt retention without snfli-
cient salt intake. Without salt retention in-
creased water intake is easily and quickly
eliminated. This is not only theoretically
true but we have been able to demonstrate in
patients in heart failure that when the salt
intake is kept at a low level the actual forcing
of fluids has no ill effects on the circulatory
dynamics. A slight increase in the salt in-
take, on the other hand, resulting in a
measurable degree of sodium retention was
followed by distinctly harmful effects on the
circulation. In this connection it is impor-
tant to remember that the actual quantity of
salt intake is not so important as the amount
of that salt that is retained. In a person in
failure an intake of 10-12 gms. of sodium
chloride in a day (the usual dietary intake
is 6-8 gms. of sodium chloride) may result in
the retention of 4-5 gms. of sodium chloride
which in turn results in a retention of about
500 cc. of fluid since fluid is retained in a
salt concentration corresponding to that of
normal saline. Since in a given patient it is
difficult without elaborate measurements to
know just how much salt can be given before
some is being retained it is simply wise to
give as little salt as possible because under
these circumstances there is the least likeli-
hood that salt, and hence fluid, will be re-
tained. There are some patients even with
slight cardiac weakness who can take 15-20
gms. of sodium chloride and excrete it all
easily. On the other hand this is not true in
all patients with cardiac weakness and hence
it is wisest to restrict the salt and take no
chances. There may be some criticism of per-
mitting increased water intake because of the
fact that this increased water intake must be
eliminated and this elimination from the cir-
culation requires some work. However, when
one recalls that the heart pumps at least
5,000 liters a day, even at rest, the adding
say of one liter of water to this total would
represent an insigTiificant amount of actual
additional cardiac work.
QUESTION : Discuss the etiology and
prevention of renal calculi.
ANSWER :
Dr. MacMahox : Renal calculi are made
up of a number of different substances, some
of which are of a protein and others of a
mineral origin. An excess of calcium, for
example, in the circulating blood is put out
through the kidneys. Here it is frequently
concentrated in the tubules to a degree of
actual precipitation. Such precipitates may
form microliths and these may be the basis
for large stone formation. Another factor is
inflammation within the kidney pelvis, an-
other is in the form of a disturbance of pelvic
epithelium as may occur in Vitamin “A” de-
ticiency. Any anomaly in the kidney that
may predispose to retention within the pelvis
will also favor stone formation or any ac-
quired obstruction to the outflow of urine.
Because many factors may combine to lead
to stone formation it is equally obvious that
a number of factors must be considered for
their prevention.
QUESTIO]^: What is the present status
of any form of insulin given orally f
AI^SWEE:
De. Dameshek ; There is no status.
QUESTIOIST : Can you have non-hemo-
lytic jaundice without hile in the urine?
ANSWERS :
De. Dameshek: Yes. If you have achol-
uric jaundice — jaundice in which the urine
doesn’t show bile — this indicates that the
blood contains indirect bilirubin which is un-
able to get by the kidney threshold ; the
hepatic cells modify it to direct bilirubin, by
removing the protein constituent. In the in-
testines urobilinogen is formed which is ex-
creted in the urine and feces. In a case of
mild jaundice, in which blood destruction is
not increased, acholuric jaundice may be
present as the result of a minor dysfunction
of hepatic cells ; the indirect bilirubin may
pass through the hepatic cells with unusual
slowness and may thus accumulate in the
blood as indirect bilirubin. A non-hemolytic
jaundice without bile in tlie urine may occur
in mild hepatic disease including early cir-
rhosis of the liver, and at the very beginning
and towards the very end of catarrhal jaun-
dice.
De. Lubell: What laboratory tests would
you recommend for this determination ?
De. Dameshek : Indirect bilirubin is de-
termined by the Van Den Bergh test with
Ehrlich’s diazo reagent, wliicli gives a blue-
color only when alcohol is added, but not di-
rectly— which is why it is called ‘^‘indirect”
— if bilirubin is present which has already
passed through the liver and “regurgitated”
back into the circulation, it will give a direct
reaction with Ehrlich’s reagent.
QUESTION : What is the status of meat
and salt in the management of hypertension?
The Journal of the Maine Medical Association
ANSWER :
De. Peogee : There is no good evidence
with which I am familiar that either meat or
salt is harmful in moderation in the ordinary
patient with hypertension. The idea that
meat might be harmful is probably related to
the feeling that meat is harmful in nephritis
and a good many patients with hypertension,
liave, to be sure, an associated nephritis. On
the other hand, more recent experiments have
indicated that even in the various stages of
glomerulo-nephritis, meat as such is not
harmful — rather it is the potassium in the
meat. Hence, meat of low potassium content
is thought to be entirely harmless even in
nephritis, whereas meat of high potassium
content such as liver or sweetbreads is best
eliminated in nephritics. However, so far as
hypertension alone is concerned, meat seems
to have no harmful effects.
The idea that salt restriction is helpful in
the management of hypertension probably
dates from Allen’s early observations. How-
ever, he employed extremely low salt intakes
under which circumstances it is quite likely
that he was producing some degree of di-
uresis as well and it is to be expected that
under these circumstances in which there is
an associated dehydration that the blood pres-
sure would drop. However, this is ]iot physio-
logical and could not be continued for an in-
detinite period of time before a salt balance
would be established on a lower level of in-
take and output at which time the lowering
effect on the blood pressure would be lost.
There seems no logical reason therefore to
restrict salt in the management of hyperten-
sion and there is also no evidence that even
a moderate increase in salt intake has any
effect on essential hypertension.
QUESTION : What is your opinion of
the treatment of Infantile Paralysis as pre-
scribed by the ''Sister Kenney” Method?
ANSWER:
De. MacMahon : Her treatment sounds
very rational and what is most important, it
appears to bring results. In infantile paraly-
sis single or groups of anterior horn cells are
injured or destroyed. Many cells are spared.
Each anterior horn may supply as many as
200-300 muscle fibres. If one of these nerve
Nineteen Hundred and Forty-two — October
225
cells is killed, those muscle fibres dependent
on it will gradually disappear. The principle
of her treatment is not to anticipate any re-
generation of killed nerve cells, but rather to
maintain the life and vitality of muscle fibres
that still have an intact and viable motor-neu-
rone. Such nerve fibres may be scattered
about among those that are paralyzed, and if
the whole area is put to rest, even the healthy
fibres will suffer atrophy of inactivity and
unnecessary deformities may result.
QUESTION : What is the relative 'per-
centage of macrocytic and hypochromic
anemia in cancers of the alimentary tract?
ANSWEIl :
1)e. Damesiiek : The great bulk of can-
cers of the gastro-intestinal tract are asso-
ciated with hypochromic anemia, since almost
always, they are associated with bleeding
which results in a reduction of hemoglobin.
Furthermore, the patient with a gastro-intes-
tinal carcinoma has a poor aj>petite and may
vomit and have diarrhea sufficiently severe to
cause a drop in the absorption of iron. In
pernicious anemia, the atrophic gastric mu-
cosa is readily subject to the development of
poly^^s and a polyp often degenerates into
carcinoma. If a carcinoma of the stomach is
present in association with macrocytic
anemia, it may be due to the underlying per-
nicious anemia.
QUESTION : Is -whole blood or plasma
preferable in the treatment of shock?
ANSWER:
De. Uameshek : In the treatment of
shock, plasma is preferable. There is already
a concentration of hemoglobin due to reduc-
tion in the plasma volume. The idea is to
increase the plasma volume, and not the red
blood cells, and this is done by giving plasma.
QUESTION : What is the mechanisyn in
Cheyne-Stokes respiration ?
ANSWER:
De. Peogee : There is no definite answer
to this question. There are various fascinat-
ing theories as to the mechanism, none of
which is anything more than a theory. The
general explanation is that as a result of an-
oxemia in heart failure there is a relatively
excessive stimulation of the respiratory cen-
ter from the carbon dioxide in the blood
which is, relative to the oxygen content,
higher than usual. As a result of this ex-
cessive carbon dioxide stimulation of the
respiratory center there is over-ventilation.
This over-ventilation results in a washing out
of a large quantity of CO2 from the system
in the expired air following which there is a
period of apnea because there is an insuffi-
cient amount of CO2 to stimulate the respira-
tory center. During hyperpnea the blood is
saturated with oxygen. During the period of
apnea, oxygen deficiency and relatively in-
creased CO2 again appear and hyperpnea
once more sets in. Cheyne-Stokes respiration
is not always of serious omen.
QUESTION : In matenial transfusions,
is it hazardous to employ the husband’s
blood?
ANSWER:
De. Dameshek: Landsteiner and Weiner
found that by injecting the blood of the
Rhesus monkey in rabbits, an anti-rhesus
agglutinin is produced, which, when mixed
with the monkey blood, causes agglutination.
This anti-monkey (anti-Rh), agglutinin when
tested with human red cells caused agglutina-
tion in 85% of all cells tested. Thus, 85%
of humans are Rh-j- and 15% Rh — . In
women dying of transfusion reactions follow-
ing transfusion of their husband’s blood, it
was found on several occasions that although
there was compatibility with the regular
blood groups, there was an actual incompati-
bility due to the fact that the woman had
developed an agglutinin which reacted with
the husband’s red cells. Eurther studies
showed that this agglutinin was the anti-Rh
factor, and that the husband’s red cells were
Rh-f-. This develops in the following man-
ner. A woman who is Rh — mates with a man
who is Rh-j-. The child will almost always
be Rh-f-. During pregnancy, some of the
foetus’s red cells may get into the maternal
circulation and immunize the mother against
the Rh factor. She will therefore develop an
anti-Rh factor, so that when the husband
(Rh-f-) gives her a transfusion, her serum
226
reacts with the husband’s red cells causing an
agglutination-hemolysis reaction. It has been
found that post-transfusion reactions oc-
curred especially in women who in the past
have had several miscarriages, stillbirths, etc.
Studies of cases of erythroblastosis foetalis
show that in most of the cases, the combina-
tion of Father Rh-|-, Mother Rh — , and the
Child Rh-|- was present. The development
of an anti-Rh agglutinin in the mother may
thus result either in a transfusion reaction or
in the child’s developing erythroblastosis
foetalis.
De. Higgins : Could you use another
woman’s blood without this test ?
Dr. Dameshek : What you want is a Rh —
donor. This is found out by using Rh testing
serum. Cross-matching by ordinary methods
is not enough; the blood must be incubated
for at least I/2 bour. True, your patient may
be in dire need of transfusion immediately,
but it is better to wait a little than to have a
death from a post-transfusion reaction.
Dr. MacMahon : Could you use plasma
instead of blood ?
Dr. Dameshek ; Ro. Here the call is for
red blood cells, and for exactly the right type
of red cells.
QUESTIOR : What is the differential
diagnosis of congenital pulmonary stenosis
and patent ductus arterio^iisf
ANSWER:
Dr. Proger: Given a patient with a
fairly loud pulmonic systolic murmur, the
question arises, is it congenital heart disease
in the first place and if so is it patent ductus
arteriosus or pulmonary stenosis. These ques-
tions are often difficult to answer. Balfour,
the famous Scottish clinician has referred,
not without good reason, to the pulmonic
area as the “area of auscultatory romance.”
If the pulmonic systolic murmur is quite
loud, the likelihood is that there is some con-
genital abnormality. If there is a relatively
high degree of cyanosis, if there is no dias-
tolic murmur over the same area, and if there
is no characteristic enlargement on X-ray in
the region of the pulmonary cone, the chances
are in favor of pulmonary stenosis. Most pa-
The Journal of the Maine Medical Association
tients with patent ductus arteriosus have a
continuous murmur with systolic accentua-
tion. It is almost always harsh, rarely blow-
ing. It is often described as being machinery-
like in character. While patent ductus ar-
teriosus occasionally occurs with just a sys-
tolic murmur, this is extremely unusual.
Also in patent ductus arteriosus, there is
rarely any significant degree of cyanosis un-
til very late, usually in the presence of heart
failure.
QUESTION : Does hile pigment ever
enter into the spinal fluid f
ANSWERS :
Dr. MacMahon : Yes, in small quanti-
ties, but I have never seen a healthy brain
discolored by it. If there is a brain tumor, an
area of inflammation or a zone of infarction
in an individual with ’ jaundice, these lesions
may be brilliantly discolored.
Dr. Gottlieb : I think the question refers
to spinal fluid.
Dr. MacMaiion : The fluid is not colored,
but bile can be detected.
QUESTION : Is typing necessary in the
administration of plasma, pooled or un-
pooled ?
ANSWER:
Dr. Dameshek : In pooled plasma, the
blood group substances neutralize each other.
Unpooled Group “O” plasma contains Anti-
“xV” and Anti-“B” agglutinins, and should
be used only for those of blood group “O.”
In others, it may result in severe reactions.
QUESTION : Assuming that the hlood
plasma is to he frozen or lyophilized, are sero-
logical examinations essential?
ANSWER:
Dr. Dameshek: Yes, always.
QUESTION : What physiological proc-
esses come into play as a result of coronary
thrombosis?
ANSWER:
Dr. Proger : There are numerous physio-
logical processes which come into play as a
Nineteen Hundred and Forty-two — October
result of coronary thrombosis. Some degree
of shock, for example, may set in with its
pathological-physiological picture. Heart fail-
ure may set in with various hemodynamic
changes. There are certain physiological
processes leading to the individual symptoms,
such as pain. I suppose what is wanted here
is more a description of the physiological
processes which lead to the sudden death
which one sees unfortunately so often in the
first few days following coronary thrombosis,
even though the pain may have been rela-
tively minor and the attack itself apparently
not ovei^vhelming. Sudden death is probably
due either to cardiac standstill or ventricular
fibrillation, but then why do ventricular fi-
brillation and cardiac standstill supervene?
Some recent dog experiments have indi-
cated that myocardial infarction may result
in widespread spasm of the coronary tree as
a result of which ventricular fibrillation may
set in with death. This widespread spasm of
the coronary vessels is presumably mediated
through the vagus nerve, the impulses having-
reached the vagus nucleus by way of afiPerent
fibres from the heart. But then one may ask,
why do these impulses arise ? It is my feel-
ing that with infarction and hence muscle tis-
sue damage certain intermediary products of
muscle metabolism or certain metabolites ap-
pear in abnormal degree and are foreign to
the heart muscle. These metabolites mav con-
*j
ceivably in a chemical manner mediate the
changes resulting in either ventricular fibril-
lation or cardiac standstill. There is good
theoretical and some experimental evidence
to indicate that this may be true.
QUESTION : In vieiu of the present war
situation, is it advisable to routinely immu-
nize patients against tetamus, typhoid and
influenza?
ANSWER:
Dr. MacMahox : At tie present time,
there is no suitable immunization against in-
fluenza and I would not think it would be
necessary to immunize against the other two
diseases if reasonable precautions could be
maintained. Men in the Army should be
immunized.
227
QUESTION : Under ivhat conditions are
negative electrocardiograms misleading?
ANSWER:
Dr. Proger: Negative electrocardiograms
should never be misleading if we simply bear
in mind that fact that a single negative elec-
trocardiogTam means nothing. In other
words, if an electrocardiogram is negative we
can onlv sav that there is no electrocar dio-
o *J
graphic evidence of heart disease and we can
say nothing more. There may be at the same
time various forms of heart disease and in
various degrees.
^ vr ^ ^ 7T
The columns entitled “Medical Queries
Answered” are intended to stimulate discus-
sion. The following discussion by Dr. Wil-
fred J. Comeau of Bangor, on questions
raised in the Question Box and published in
the January issue of The Jourhal of the
Maixe Medicae Associatiox is of un-
doubted value. The questions are therefore
reprinted, together with Dr. Comeau’s criti-
cal comments :
QUESTION : Is digitalis indicated in
myocardial failure due to coronary occlusion?
ANSWERS :
Dr. Pratt : No,
Dr. Karsher : It seems illogical to me.
Dr. Dameshek : Don’t some cases get
right-sided failure and congestion of the liver
— isn’t it good then ? But in left-sided ven-
tricular failure, it wouldn’t be useful. If a
patient develops rales, it might be worth
while.
Dr. Goodwin: Eollowing an acute coro-
nary where the heart is rapid and irregular,
what would you use ?
Dr. Pratt : I think opium in acute heart
failure is the most valuable drug to employ.
Dr. Dameshek : In the case of coronary
thrombosis with irregular, rapid heart action,
quinidine may be very helpful, and may even
prevent dreaded ventricular flbrillation.
Eollowing is Dr. Comeau’s comment :
“With due respect to Drs. Earsner, Pratt
and Dameshek, I was amazed at the answers
to the question: Us digitalis indicated in
228
The Journal of the Maine Medical Association
myocardial failure due to coronary occlusion ?
I believe you will find that most cardiologists
and internists will agree that although digi-
talis is not indicated in pure myocardial in-
farction, it is extremely important to use it
if and when the signs and symptoms of heart
failure appear following coronary throm-
bosis. The impression given in the answers to
the question is pretty definitely against the
use of digitalis. Since these questions will
probably be read by a great many general
practitioners, this answer may lead to the
avoidance of digitalis in cases of heart fail-
ure following coronary occlusion when it cer-
tainly should be utilized as quickly as
possible.”
QUESTIOlSr : What is the relation be-
tween angina pectoris and coronary occlu-
sion ?
ANSWERS :
De. Peatt : Many cases of severe angina
pectoris are due to occlusion of a small
branch of a coronary artery. Both are dis-
eases of the coronary artery, resulting in an-
oxemia of the heart muscle.
De. Kaeshnee : It is now generally ac-
cepted that the symptoms of angina pectoris
depend on anoxemia of the myocardium. This
may be an anoxemia due to obliterative dis-
ease of the coronary arteries, or it may be a
relative anoxemia in which the work of the
heart is in excess of the capacity of the coro-
nary circulation. Autopsies on cases of an-
gina pectoris usually show coronary sclerosis
and there are but few cases reported in which
this is not true. It seems to me that it is im-
possil)le to make a differential diagnosis be-
tween angina and coronary occlusion without
study of the electrocardiogram but it must be
admitted that this is not a final and absolute
criterion because even in cases of myocardial
infarction, the electrocardiogram may not
show any material disturbances.
De. Peatt: There are a great many Indi-
viduals who have mild angina on slight exer-
tion in which the electrocardiogi-am is nor-
mal. In any case of severe angina, an electro-
cardiogi’am should be made.
De. Kaesnee: Patients also may have
coronary occlusion with little or no pain.
De. Goonwix: Those who do not have
pain do have a sense of pressure that doesn’t
amount to pain.
De. Peatt : Substernal pressure on exer-
tion is of diagnostic significance in angina.
De. Goodwin: Does nitro-glycerin give
you any clue ?
De. Peatt : If nitro-glycerin gives relief
it tends to confirm the diagnosis of angina.
De. Dameshek: Angina pectoris is a
symptom and usually of coronary disease.
The term coronary thrombosis might well be
dropped as a clinical diagnosis, when what
we really mean is myocardial infarction,
which may or may not be due to coronary
occlusion.
De. Kaesnee : Your patient who has pres-
sure and no pain — does it come on exertion ?
De. Goodwin : It conies on with exertion.
De. Gottlieb : I have seen many cases of
coronary occlusion in which the electrocardio-
aTanis were normal. In one case there were
O
fourteen lesions each occluding a coronary
branch and yet the electrocardiognaphic trac-
ings were all within normal range at various
times. Often electrocardiograms indicating
occlusion become negative subsequent to the
healing process of the myocardium distal to
the occlusion with or without recanalization
of the vessels. If an occlusion occurs as a
slow, progressive process permitting oppor-
tunity for the establishment of a collateral
circulation, the electrocardiographic tracing-
will at no time show any evidence of the
occlusion. Of course, acute occlusion is regu-
larly mirrored in the tracing not because of
the occlusion, but because of the distally in-
farcted myocardium.
Pollowing is Dr. Comeau’s comment :
“Again, Dr. Karsner’s remark in the ques-
tion: 'What is the relation between angina
pectoris and coronary occlusion?’ where he
states that the differential diagnosis between
angina, pectoris and coronary occlusion cannot
be made without the electrocardiogram, I be-
lieve gives somewhat of a wrong impression.
In the majority of cases this differential diag-
Continued on page 237
Nineteen Hundred and Forty-two — October
229
Cancer of the Stomach
By At.letst G. Beailey, ]\I. I)., Brookline, ^Massachusetts
The importance of cancer of the stomach
as a problem in diagnosis and treatment can
he emphasized in several ways. EMr instance,
disease in this one organ causes between one-
qnarter and one-third of all deaths due to
cancer. It causes nearly one-half of all male
deaths dne to cancer. It causes from thirty to
fifty thousand deaths per year in the United
States alone of which about one-quarter are
women and three-quarters men. It consti-
tutes about 10 per cent of all cancer occur-
ring in the gastrointestinal tract and it is
nearly twice as common, for example, as
cancer of the colon.
The only form of treatment of cancer of
the stomach which offers any hope of cure is
surgical removal of the new growth and of a
considerable portion of the surrounding stom-
ach. Concerning even gastric resection there
is widespread feeling of hopelessness and
futility. The cures obtained are all too few
in number and many a physician has never
seen a cured patient. For several reasons the
reports of the results of treatment are ex-
tremely confusing. In the first place only a
few surgeons in the world have individually
resected more than a small number of stom-
achs so that their results of whatever nature
will be based on too few cases to be statisti-
cally significant. Then, also, any cures ob-
tained may be reported in a variety of ways.
They may be reported as a percentage of the
total nmnber of gastric cancer cases seen.
They may be reported as a percentage of the
total number of patients explored. They may
be reported as a percentage of the total num-
ber of those explored in whom it was found
possible to resect the lesion. They may be re-
j)orted as a percentage of those patients who
survived operation, etc., etc. The picture is
further confused by the fact that one author
may report as presnmptive cures, those alive
and well at the end of three years, and others
those alive and well at the end of five vears,
and still others report only those who have
survived ten years and so on. Unless these
facts are borne carefully in mind it will be
found impossible to coni] >a re the results of
resection in one clinic with those in another
clinic or to form any accurate impression of
the status of surgical treatment. A recent
monograph by Livingston and Pack’- en-
titled, ‘‘End Results in the Treatment of
Gastric Cancer” constitutes an analysis of all
reported gastric resections for cancer from
the time of Theodore Billroch, who made the
first snccessful resection sixty years ago, and
it weighs and corrects these sources of con-
fusion in published statistics.
In order to get a fair picture of the results
which may be obtained by gastric resection
for cancer, it is important to separate the
total number of cases into two distinct
groups. First, resectable cancer and second,
non-resectable cancer. ATon-resectable cancer
constitutes those cases already so far ad-
vanced when first seen that there is no possi-
bility of removing the growth in toto. The
situation of such patients is completely hojie-
less and their death rate of 100% should not
be laid at the door of the surgeon who could
not help them nor should it be allowed to
obscure completely the good results which
may be oldaiiied in resectable cancer. At the
present time about 75% of all cases of gastric
cancer are in an obviously hopeless state
when first seen. Cooper" in an analysis of
261 cases found that he could divide the re-
sponsibility for late diagnosis between the pa-
fient, his family physician and the general
hospital about as follows : The patient could
,be blamed for a delay of about 8 months from
the time his earliest symptoms appeared, his
physician for an additional four and one-half
months from the time that the patient first
appealed to him, and the general hospital for
delay of one month or more after the patient
was admitted for study. Obviously there is
an initial period after cancer cells first de-
velop during which no symptoms whatever
are produced and which must represent an
irreducible minimum of delay between the
230
onset of disease and the possibility of treat-
ment l)iit we can liope to diminish these
cnmnlative dela^’^s which occur after symp-
toms are j^rodnced and for wliich the hnrden
of guilt mnst he divided between the patient
and the nrofession. Increasing efforts must
he made to educate the public as to the
possible significance of early symptoms and
to the need of consulting the doctor early for
his interpretation. An increasing effort mnst
,also be made to teach the doctor to consider
the possibility of cancer first and not after a
long course of ulcer treatment has proved in-
effective. The diagnostic tool of paramount
value is the gastro-intestinal series when com-
petently done. It will have to he used much
more frequently in the future if more cancer
of the stomach is to he discovered in a resect-
able stage. It is very interesting, however,
that the greater the experience of any given
surgical clinic the greater the percentage of
total cancer cases which it finds resectable.
Surgeons are still far short of their goal in
this regard as attested by the fact that when
persons who die of cancer of the stomach are
anto^isied approximately one-fourth have the
disease still limited to the stomach or to the
stomach and immediately adjacent lymph
cells.
At the present time about fifteen to thirty-
five percent of gastric cancer cases are found
to he resectable depending on the clinic re-
porting, hut this represents no negligible
amount of disease. Jt is estimated that there
are about ten thousand persons who come to
doctors in the United States every year who
have gastric cancer in a resectable state, that
is, a 2)i‘<?snmptively curable state. Ho such
number are cured, however. The discrepancy
between the nnniber who might conceivably
be cured and those who are in fact ultimately
cured is made up first of a considerable niini-
her who die as the result of the operation.
One mnst also subtract those persons who
have a recurrence of the disease in spite of
surgical efforts. Such cases are an indication
of fallible judgment as to how much tissue
should have been removed. Finally one must
sid)tract those who die of intercnrrent disease
before they can reach the end of the chosen
follow-up period of 5 years or 10 years.
Since gastric cancer is a disease of elderly
people the nnniber who will certainly die of
The Journal of the Maine Medical Association
other diseases during the succeeding five or
ten years is fairly considerable. Of all pa-
tients with cancer of the stomach who submit
to gastric resection about 25% are alive and
well at the end of 5 years but if one selects
those cases whose disease was confined to the
stomach wall, 55 .to 00% are alive and well
at the end of 5 years. It is possible, then, to
look at this problem from two points of view.
If one’s attention is focussed on the total in-
cidence of cancer of the stomach, it is ex-
tremely disheartening to be told that less than
5% are alive at the end of 5 years. If, on
the other hand, one’s attention is fixed on
those for whom treatment offers some hope,
that is resectable cancer, then the percentage
of cures which we have already obtained
takes on a very impressive and stimulating
significance.
The life history of this disease may be di-
vided into three periods. First, there is an
early period during which the lesion is too
small to produce any clinical symptoms. The
duration of this period may be measured by
a few weeks or by several months. If the
disease is close to the pylorus and of a high
grade of malignancy it will obviously pro-
duce symptoms early whereas a lesion of the
fundus of low malignancy will be slow tc
cause significant trouble. This first or silent
period is followed by a period of clinical
symjDtoms. These symptoms are vague at
first. They do not compel a consideration of
cancer, frequently they do not even compel
consideration of the stomach as a disease
focus. Finally there is a third stage when
cachexia, obstruction, hematemesis or pal-
pable metastases make the diagnosis mani-
fest. During the first or silent period and
during the third or late period, the disease is
beyond onr grasp but the second period of
early symptoms deserves our closest con-
sideration. Often the first complaint is a
sense of fullness after meals. Often the pa-
tient begins soon to lose a little weight be-
cause the sense of fullness is relieved by eat-
ing less. Soon the desire for food begins to
fall off. Increased gassiness is early com-
plained of and increased belching. Stomach
distress is often momentarily relieved by
swallowing and since a little air is carried
down with each act of swallowing more air
accumulates in the fundus to be belched up
Nineteen Hundred and Forty-two— October
231
again. Nausea and vomiting may appear
early if the lesion is close enough to the
pylorus to produce an element of obstruction.
In about 25 or 30 of patients unwonted
constipation is the first symptom complained
of.
X-ray examination of the stomach is the
diagnostic weapon which must he chiefly re-
lied upon. A single negative report cannot he
accepted but the examination must be re-
peated if the symptoms persist. At this point
the doctor will often be confronted witli the
problem of differentiating between cancer
and benign gastric ulcer. Gastric analysis for
the determination of free acid is of some
value hut it is not definitive. In general, of
course, cancer of the stomach is associated
with stomach contents which contain little or
no free acid. Oughterson and Irons^ report-
ing on a series of 126 cases found a free acid
of more than 15 units in only 7, or 5^%.
Gastroscopy^ should be employed more fre-
quently. An ulcer with a clean base and
sharply defined margin will usually prove to
he benign, whereas one with a dirty base and
a nodular border is probably cancer. The lo-
cation of the ulcer is an extremely valuable
differential point. Hampton and Holmes®
have shown that 75% of ulcers occurring
within 1 inch of the pylorus proved on patho-
logical examination to be cancer. One should
not be lulled into a sense of security because
the symptoms regress on ulcer treatment or
because the lesion actually appears to grow
smaller by X-ray observation, since it has
been shown that lesions which are actually
cancer may so improve for a short time.
Stools should be examined for occult blood.
Preferably this examination should be de-
ferred until the patient has been on a diet
without meat or iron-containing medication
for at least three days. If blood is found, it
simply presumes an oozing lesion somewhere
in the digestive tract and says nothing as to
its nature or location. One must not forget
the possibility that the patient harbors an
ulcerating lesion in the colon as well as the
stomach.
When it is decided that the patient has a
lesion of the stomach which may be cancer,
the question of its resectability will at once
arise. IMucli less importance should be at-
tached to the size of the mass as apparent by
X-ray or gastroscopy. Experience has shown
that highly malignant cancer may have me-
tastasized widely within a few months of the
onset of symptoms and while the primary
focus is still comparatively small. On the
other hand, cancer of lesser malignant grade
may have produced a large ulcerating mass
and have led to an alarming decline in health
and yet be confined to the stomach and imme-
diately adjacent lymph nodes. Peritoneo-
scopy’ should be used far more widely in de-
ciding the question of operability. It is a
simple procedure involving a negligible risk
to the patient. By its use the experienced
endoscopist seldom has any difiiculty in get-
ting a. direct view of the peritoneum (includ-
ing the pelvis), the liver, the stomach and its
adjacent lymph drainage. In some cases his
report will encourage an attempt at resection
in patients who appeared clinically to be
probably inoperable. In others his demon-
stration of widespread metastases will spare
persons already ill the additional expense and
suffering of laporatomy.
Bibliogeapiit
1. Livingston and Pack; “End Results in the
Treatment of Gastric Cancer.”
2. Cooper, W. A.; “The Problem of Gastric Can-
cer.” J. A. 31. A., 116:2125-2159, May 10, 1941.
3. Parsons, Laugdon: “Operative Curability of
Carcinoma of the Stomach.” New England J.
Medicine, 209:1096-1101, November 30, 1933.
4. Oughterson, A. W., and Irons, H. Stewart:
“The Diagnosis of Cancer of the Stomach and
Colon.” International Clinics. 1:157-172, March,
1941.
5. Benedict, E. B.: “Surgery of the Stomach and
Duodenum: Gastroscopic Examination.” Neio
England J. of Medicine, 222:427-434, March 14,
1940.
6. Hampton, A. 0., and Holmes, G. W. : “The Im-
portance of Location in the Differential Diag-
nosis of Benign and Malignant Gastric Ulcera-
tions.” Neio England J. of Medicine, 208:971-
976, May 4, 1933.
7. Ruddock, J. C.: “Peritoneoscopy, Surgery,
Gynecology and Obstetrics,” 65:623-639, No-
vember, 1937.
232
The Journal of the Maine Medical Association
Editorial
Appointment and Promotion of Doctors in Service
The new policy of appointment and promo-
tion of medical officers in the service, an-
nonnced by the Surgeon . General of the
Army, became effective on September 15,
1942.
This is a sound policy designed to fill po-
sition vacancies by promotion of men already
in the service, insofar as possible, and by
raising the standards for appointment in
grades above that of First Lieutenant, and
so make achievement the basis of promotion.
The following l)idletin from The Office of
the Surgeon General will clarify this policy.
“The Surgeon General of the Army pub-
lished detailed information concerning jDoli-
cies governing the initial appointment of
physicians as medical officers on April 23.
1942. ISTecessary changes are given wide pub-
licity, at his resuest, in order that the indi-
vidual apj^licants, and all concerned in the
procurement of medical officers, may know
the status of such appointments.
“The current military program provides
for a definite number of position vacancies in
the different grades. The number of such po-
sitions must necessarily determine the pro-
motion of officers already on duty and, in
addition, the appointment of new officers
from civilian life. Such appointments are
limited to qualified physicians required to fill
the position vacancies for which no equally
well qualified medical officers are available.
Such positions callmg for an increase in grade
should should he filled hy promotion of those
already in the service, insofar as possible,
and not hy neiv appointments.
“If this policy is not followed, it woidd
definitely penalize a large number of well
qualified Lieutenants and Captains already
on duty by blocking their promotions which
have been earned by hard work. In view of
these facts, it has heen deemed necessary to
raise the standards of training and experience
for appointment in grades above that of First
Lieutenant.
“With this in view, the Surgeon General
has announced the following policy which
will govern action to be taken on all applica-
tions after September 15, 1942.
“x\ll appointments will be recommended in
the grade of First Lieutenant with the follow-
ing exceptions :
CAPTAIN
“1. Eligible applicants between the ages of 37
and 45 will be considered for appointment in the
grade of Captain by reason of their age and gen-
eral unclassified medical training and experience.
“2. Below the age of 37 and ABOVE the age of
32, CONSIDERATION for appointment in the
grade of Captain will be given to applicants who
meet all of the following minimum requirements:
“a. Graduation from an approved medical
school.
“b. Internship of not less than one year,
preferably of the rotating type.
“c. Special training consisting of three years’
residency in a recognized specialty.
“d. An additional period of not less than two
years of study and/or practice limited
to the specialty.
“3. Eligible applicants who previously held
commissions in the grade of Captain in the Medical
Corps (Regular Army, National Guard of the
United States, or Officers’ Reserve Corps) MAY
BE CONSIDERED for appointment in that grade
provided they have not passed the age of 45 years.
MAJOR
“1. Eligible applicants between the ages of 37
and 55 MAY BE CONSIDERED for appointment
under the following conditions:
“a. Graduation from an approved school.
“b. Internship of not less than one year, pref-
erably of the rotating type.
“c. Special training consisting of three years’
residency in a recognized specialty.
“d. An additional period of not less than seven
years of study and/or practice limited
to the specialty.
“e. The existence of appropriate position va-
cancies.
“f. Additional training of a special nature of
value to the military service, in lieu of
the above.
“2. Applicants previously commissioned as Ma-
jors in the Medical Corps (Regular Army, National
Guard of the United States, or Officers’ Reserve
Corps) whose training and experience qualify them
for appropriate assignments may be CONSIDERED
for appointment in the grade of Major provided
they have not passed the age of 55.
LIEUTENANT COLONEL AND COLONEL
“In view of the small number of assignment va-
cancies for individuals of such grade, and the
large number of Reserve Officers of these grades
who are being called to duty, such appointments
will be limited. Wherever possible, promotion of
qualified officers on duty will he utilized to fill the
position vacancies.
Nineteen Hundred and Forty-two — October
“Much mismiderstaiiding’ has arisen con-
cerning recognition hy Specialty Boards and
memhership in specialty groups. It will be
noted that mention is not made of these in the
preceding paragraphs. This is due to the va-
riation in requirements of the different
Boards and organizations. Membership and
recognition are definite factors in determin-
ing the professional backgi-onnd of the indi-
vidual, but are NOT the deciding factors, as
so many physicians have been led to believe.
“The action of the Grading Board, estab-
lished by the Surgeon General in his office,
is final in tendering initial appointments.
I^roj^er consideration must 1)6 given such fac-
tors as age, position vacancies, the functions
of command, and original assignments. All
233
questionabl}’’ initial grades are decided by
this board. Due to the lack of time, no recon-
sideration can be given.
“There are in the age group 24-45 more
than a sufficient number of eligible, qualified
physicians to meet the Medical Department
requirements. It is upon this age group that
the Congress has imposed a definite obliga-
tion of military service through the medium
of the Selective Service Act. The physicians
in this group are ones needed NOW for ac-
tive duty. The requirements are immediate
and imperati’^'e. Applicants beyond 45 years
may be considered for appointment only if
they possess special (pialifications for assign-
ment to positions appro] >ri ate to the grade of
MAJOR or above.”
Maternal and Child W elf are
BREATVTAL CARE
AAAmen’s magazines, newspapers, the Bu-
reau of Health and its visiting nurses are
constantly telling the expectant mother to
“see your doctor.” Many women are taking
tliis advice seriously and many ]:>hysicians
are demonstrating its wisdom. There are,
however, many women who are disappointed
by their visit to the doctor, receiving only a
hurried check on blood pressure and urine
and being told to “Call me when you need
me.” Such a man is not only denying his
patient comfort and guidance through a pe-
riod which is to her momentous, perplexing,
and sometimes terrifying, but is denying him-
self the assurance that comes from being fore-
warned and therefore forearmed. The ac-
coucheur who comes to the delivery room
knowing that he is faced with a breech pre-
sentation or a contracted pelvis, or that the
parturient has mitral stenosis, is not con-
fronted with the painful surprises that bring
midnight panic to one who was snoozing hap-
pily in the blissfully ignorant hope that
“everything would be normal.”
What then are the minimum requirements
of adequate prenatal care that will do justice
to the patient and the physician ? The fol-
lowing seem to us reasonable : Educate your
patients to come to you EARLY in preg-
nancy. At the first visit enquire into the fam-
ily history for constitutional disease or ob-
stetric difficulties in the immediate family,
and the health of husband and children if
any. The duration of the marriage has some
bearing. If this is the first pregnancy after
years of marriage, glandular defect in one
partner should be thought of. Furthermore,
this patient is likely to wish particular in-
struction in means of avoiding a miscarriage.
The personal history should be taken par-
ticularly for serious infections, diseases of
the heart, lungs, or kidneys, operations or in-
juries, especially those involving the lower
abdomen or pelvis. The menstrual history, if
abnormal, may suggest glandular disorder.
The course of previous pregnancies, deliv-
eries, and puerperia, and the size of babies
are important. The history of the present
pregnancy includes the date of the last pe-
riod, enquiries for nausea, heartburn, head-
ache, visual difficulties, constipation, fre-
quency, dysuria, oedema.
At this first visit a complete physical ex-
amination should be done. The height,
weight, pulse, and blood pressure are re-
corded. Note is made of the general body
build and distribntion of fat and hair. Spe-
cial attention is directed to the teeth, tonsils,
234
The Journal of the Maine Medical Association
thyroid, heart, lungs, abdomen (scars, her-
nia) and extremities (oedema, varicosities).
Pelvic examination discloses the state of
the vaginal outlet and gives warning of
possible unusual resistance. The state and
])Osition of the fundus and cervix are noted
and adnexal masses and tenderness found if
present. At this time the inclination of the
sacrum and size of the bony outlet can be
determined. If the promontory of the sacrum
can be touched by the examining finger, or if
the pubic arch is narrow the physician is
warned of trouble then and there. The dis-
tance between the tuberosities of the ischia is
now determined and the anus inspected for
hemorrhoids and stricture.
If the pregnancy is sufficiently advanced,
the height of the fundus, the position and con-
dition of the foetus (foetal heart), and the
amount of amniotic fluid are estimated. The
external measurements of the pelvis are de-
termined, particularly the intercristal, inter-
spinous, and external conjugate.
A moderate amount of lal)oratory work is
essential. The hemoglobin should be deter-
mined and blood sent away for a Kahn test.
The urine is tested for specific gravity, re-
action, presence of albumen, glucose, blood
cells and casts in the sediment.
On the basis of information obtained from
this examination (most of which takes less
time to do than to write) the patient should
be explicitly advised. If everything is nor-
mal, she should be told so, the calculated date
of confinement stated, and general advice as
to hygienic living given. Diet, work, rest,
recreation, exercise, bathing, and intercourse
should be mentioned as the patient is often
anxious about them and frequently too bash-
ful to ask questions. Abnormalities, if found,
should be pointed out in a way calculated to
secure cooperation in treatment while arous-
ing as little alarm as possible. She should be
advised to see her dentist.
The patient’s questions should be answered
briefly but clearly without the use of techni-
calities. A diagram or model of the pelvis is
often useful. She should be warned that
there are people who love to talk about the
obstetric disasters they have heard about, and
others who offer distinctly bad advice. Tell
her she may feel free to ask you about aii}^
problems.
Finally, warn the patient to tell you at
once of the occurrence of unusual headache,
Iflurring of vision, or vaginal bleeding. Ad'
monition to return in a month, bringing a
specimen of urine ends the interview.
At subse(pient visits the weight and blood
pressure are always recorded and the urine
examined. After the patient’s general state-
ment of her condition, specific questions are
asked concerning the cardinal symptoms of
toxemia (headache, blurring of vision, ab-
dominal pain, oedema). At suitable intervals
the height of the fundus and the position and
condition of the fetus are determined. If ad-
ditional calcium and vitamins are needed
the}^ should be prescribed. Remedies for con-
stipation and hemorrhoids should not be left
to the patient. It is often wise to prescribe
iron.
At the fourth or fifth month the patient
usually wishes to know about a maternity
girdle. Most women are more comfortable
with one. The physician may send her to a
reliable corsetiere or tell her the principles to
be observed in choosing one. A firm back and
a non-constricting, boneless, shell-like front
are the essentials. The brassiere should be of
the uplift type. Broad, low-healed shoes and
loose but attractively colored and styled
dresses will add much to the comfort and
pleasure of the mother-to-be.
At the sixth or seventh month attention
should be directed to the breasts. The pa-
tient, if healthy, should be influenced as
strongly as possible to nurse her baby. (More
about this later). Daily washing of the
nipples with soap and water, followed by al-
cohol, and then by lanolin or cocoa butter
will do much to prepare them for their func-
tion. The idea is to keep them soft. (You
wouldn’t “harden” chapped hands, would
you?) If they are flat or moderately in-
verted,, they may be gently drawn out.
After the seventh month vigilance should
be increased and if any rise in the blood pres-
sure, particularly the diastolic, unduly rapid
increase in weight, or albuminuria appears,
fortnightly or weekly visits should be de-
manded and appropriate precautionary meas-
ures taken. The hemoglobin should be esti-
mated again. The patient must be specifically
told to report symptoms of trouble.
{To be continued.)
Your Committee on Maternal
AND Child Welfare.
Nineteen Hundred and Forty-two — October
235
COUNTY SOCIETIES
Androscoggin
President, Camp C. Thomas, M. D., Lewiston
Secretary, Charles W. Steele, M, D., Lewiston
Aroostook
President, Thomas G. Harvey, M. D., Mars Hill
Secretary, Clyde I. Swett, M. D., Island Falls
Cumberland
President, Roland B. Moore, M. D., Portland
Secretary, Eugene E. O’Donnell, M. D., Portland
Franklin
President, James W. Reed, M. D., Earmington
Secretary, George L. Pratt, M. D., Earmington
Hancock
President, Ralph W. Wakefield, M. D., Bar Harbor
Secretary, M. A. Torrey, M. D., Ellsworth
Kennebec
President, L. Armand Guite, M. D., Waterville
Secretary, Erederick R. Carter, M. D., Augusta
Knox
President, James Carswell, M. D., Camden
Secretary, A. J. Fuller, M. D., Pemaquid
Linco In-Sagadahoc
President, Edwin M. Fuller, Jr., M. D., Bath
Secretary, Jacob Smith, M. D., Bath
Oxford
President, Albert P. Royal, M. D., Rumford
Secretary, J. S. Sturtevant, M. D., Dixfield
Penobscot
President, Albert W. Fellows, M. D., Bangor
Secretary, Forrest B. Ames, M. D., Bangor
Piscataquis
President, Albert M. Cardy, M. D., Milo
Secretary, Harvey C. Bundy, M. D., Milo
Somerset
President, Allan J. Stinchfield, M. D., Skowhegan
Secretary, M. E. Lord, M. D., Skowhegan
Waldo
President, Lester R. Nesbitt, M. D., Bucksport
Secretary, R. L. Torrey, M. D., Searsport
Washington
President, Perley J. Mundie, M. D., Calais
Secretary, James C. Bates, M. D., Eastport
York
President, Carl E. Richards, M. D., Alfred
Secretary, C. W. Kinghorn, M. D., Kittery
County News and Notes
Kennebec
A meeting of the Kennebec County Medical Asso-
ciation was held at the Augusta House, Augusta,
Maine, Thursday evening, September 17, 1942.
Dinner at 6.30 P. M., which was followed by a
business meeting. Minutes of the last meeting
were read and approved.
It was voted to omit the October and November
meetings and to hold the annual meeting at the
Augusta State Hospital on the second Thursday in
December.
It was also voted that because of the shortage of
physicians as the result of so many having gone
into military service, and because of the rationing
of gasoline and the restrictions on rubber, that a
committee of three be appointed to write a series
of articles to be published in the Kennebec Journal
and the Waterville Sentinel, containing sugges-
tions whereby the public can aid the medical pro-
fession in making the most efficient utilization
possible of available medical service. The commit-
tee was appointed as follows: George R. Campbell,
M. D., Augusta; Blynn 0. Goodrich, M. D., Water-
ville; and Chalmers G. Farrell, M. D., Gardiner.
Carl H. Stevens, M. D., of Belfast, President of
the Maine Medical Association, was present and
spoke of matters pertaining to the State Associa-
tion and the physicians in medical service.
The speaker of the evening was Brig. Gen. John
G. Towne, whose subject was Procurement and
Assignment of Medical Officers for the Army. He
stated that Kennebec County had the largest per-
centage of physicians in military service of any
county in the state and that Maine’s quota for the
year was already filled.
Gen. Towne’s subject was discussed by George
E. Heels, Captain, M. C., Medical Officer, Recruit-
ing and Induction Station, Portland, Maine, who
offered many additional facts.
Both speakers were very interesting and their
remarks were followed by a general discussion.
There were 31 members and guests present.
Respectfully submitted,
Frederick R. Carter, M. D.,
Secretary.
Piscataquis
The Annual Meeting of the Piscataquis County
Medical Association was held at the Mayo Me-
morial Hospital, Dover-Foxcroft, Maine, on Sep-
tember 17, 1942, with seven members out of a
possible eleven present.
The following officers were elected for the com-
ing year:
President: Albert M. Carde, M. D., Milo.
Vice-President: Ralph C. Stuart, M. D., Guilford.
Secretary-Treasurer: Harvey C. Bundy, M. D.,
Milo.
Harvey C. Bundy,
Secretary.
Change of Address
Adrian H. Scolten, M. D.
From: 201 State Street, Portland, Maine
To: 32 Deering Street, Portland, Maine
236
The Journal of the Maine Medical Association
Members in Military Service"^'
Oxford
Corliss, Leland M.,
West Paris
Piscataquis
Howard, George C.,
Thomas, Ruth B.,
Guilford
Dover-Foxcroft
Somerset
Ball, Franklin P., Bingham
* Under this heading will be published, in eacdi issue,
a list of members in military service as received at this
office during the past month. Complete list to August
25, 1942, published in the September, 1942, issue of the
JOURNAL, pages 213, 214.
Necrology
Anthony D. J. Pelletier, M, D.
Anthony D. J. Pelletier, M. D., born in Lewiston,
was accidentally drowned in Mooselookmeguntic
Lake, on July 4, 1942. He was the son of Mrs.
Rose Pelletier and the late Doctor Joseph Pelletier
of Bridge St., Lewiston. He attended the Lewiston
public schools, graduating from Lewiston High
School in 1926. He was always very fond of fish-
ing and hunting, especially in the Rangeley region
where he spent many vacations.
Doctor Pelletier attended the University of
Maine where he was an outstanding student and
popular among his classmates. He graduated in
1930 and went directly to Yale Medical School,
where he graduated in 1934 in the upper third of
his class. In the same year he married Miss
Barbara Hunt of Portland and continued his
studies as interne in the Kings County Hospital,
Long Island City, New York. There he specialized
in Surgery and then returned to Lewiston to begin
practice there in 1936.
He soon received an appointment on the medi-
cal service of the Central Maine General Hospital
and was an adjunct of the thyroid service. He was
popular among his patients as well as the doctors
of the two cities and had just moved into a fine
residence when he met his untimely death.
He leaves his wife, one son and his mother, his
father having passed away a few years ago. Many
families in the vicinity of Lewiston and Auburn
have lost a very dear friend and family physician,
and the Medical Society of Maine has lost a well-
trained, capable surgeon.
W. P. W.
Notices
C ommunity Blood Donor Service, Inc.
The Community Blood Donor Service, Inc., lo-
cated at the Maine General Hospital, 22 Arsenal
Street, Portland, has been formed to establish and
maintain a Blood Bank for war or other emergen-
cies arising in hospitals connected with the ser-
vice. This service is being conducted under the
auspices of the York and Cumberland County
Medical Societies and is sponsored by the Office of
Civilian Defense.
Blood donors are needed, especially men, in
order that a sufficient supply of plasma may be
stored in hospitals in York and Cumberland coun-
ties, and be available when the need arises,
Thomas W. Goad,
Executive /Secretary.
State of Maine
Board of Registration of Medicine
Adam P. Leighton, M. D., Portland, Secretary.
List of Applicants Passing the State Board on
July 8, 1942.
Through Written Examination
Robert Laurie Allen, M. D., Rockland, Maine.
John Littlefield Buckley, M. D., 52 Neal Street,
Portland, Maine.
John Hurlbut Buell, M. D., U. S. Marine Hospi-
tal, Detroit, Michigan.
Paul W. Burke, M. D., Water Works, State
Street, Bangor, Maine.
Carl Cricco, M. D., 708 Jefferson Street, Hobo-
ken, N. J.
William B. Gellman, M. D., Molly Stark Sana-
torium, Canton, Ohio.
Leon George Hagopian. M. D., Manset, Maine.
Howard Thomas Karsner, M. D., Western Re-
serve University, Cleveland, Ohio.
Preston Kyes, M. D., North Jay, Maine.
Rolf Lium, M. D., 388 State Street, Portsmouth,
N. H.
John E. Lorenz, M. D., c/o Bethseda Hospital,
Cincinnati, Ohio.
Charles Alexander Macgregor, M. D., 7 Knox
Street, Rumford, Maine.
Edward Atkinson McFarland, M. D., Lisbon
Falls, Maine.
Albert Willis Moulton, Jr., M. D., 180 State
Street, Portland, Maine.
Abraham Leib Rauchwerger, M. D., Methodist
Hospital of Central Illinois, Peoria, 111.
Merrill Benjamin Rubinow, M. D., 192 E. Center
Street, Manchester, Conn.
Kurt Arthur Sommerfeld, M. D., Camp Mena-
toma, Kents Hill, Maine.
George J. B. Weiss, M. D., Bellevue Hospital,
New York, N. Y.
Through Reciprocity
Mary Bruins Allison, M. D., Grindstone Inn,
Winter Harbor, Maine.
John R. Davies, Jr., 2 E. Chestnut Ave., Phila-
delphia, Pa.
Richard Arthur Durham, M. D., 25 Argilla Road,
Ipswich, Mass.
Armand Stanley Lincourt, M. D., Box 288, West-
boro, Mass.
Nineteen Hundred and Forty-two — October
Ota C. Loud, M. D., 45 Highland Ave., Bangor,
Maine.
Roland Lawton McCormack, M. D., Norway,
Maine.
Frances Campbell Mclnnes, M. D., Cobb’s Camps,
Denmark, Maine.
Frederick Zerkowitz, M. D., St. Mary’s Hospital,
Waterbury, Conn.
Examinations
American Board of Obstetrics and
Gynecology
The next written examination and review of
case histories (Part I) for all candidates will be
held in various cities of the United States and
Canada on Saturday, February 13, 1943, at 2.00
P. M. Candidates who successfully complete the
Part I examination proceed automatically to the
Part II examination held later in the year. All
applications must be in the office of the Secretary
by November 16, 1942.
Effective this year there will be only one gen-
eral classification of candidates, all now being re-
quired to have been out of medical school not less
than eight years, and in that time to have completed
an approved one year general rotating interneship
and at least three years of approved special formal
training, or its equivalent, in the seven years fol-
lowing the interne year. This Board’s require-
ments for interneships and special training are
similar to those of the American Medical Associ-
ation, since the Board and the A. M. A. are at
present cooperating in a survey of acceptable in-
stitutions. All candidates must be full citizens of
the United States or Canada before being eligible
for admission to examinations.
All candidates will be required to take the Part
I examination, which consists of a written exami-
nation and the submission of twenty -five (25) case
history abstracts, and the Part II examination
(oral-clinical and pathology examination). The
Part I examination will be arranged so that the
candidate may take it at or near his place of resi-
dence, while the Part II examination will be held
late in May, 1943, in that city nearest to the
largest group of candidates. Time and place of
this latter will be announced later.
For further information and application blanks,
address Dr. Paul Titus, Secretary, 1015 Highland
Building, Pittsburgh (6), Pennsylvania.
237
Peptic Ulcer Film Available
There is now available for free showings before
groups of physicians the first complete movie film
on peptic ulcer, in color and with sound track.
The film is entitled “Peptic Ulcer” and was
produced under the direction of the Department
of Gastroenterology of the Lahey Clinic of Boston.
The American College of Surgeons has awarded
its seal of approval to the film.
Running time of the film is 45 minutes, 1,600
feet of 16 mm. film, and covers a presentation of
the following problems of peptic ulcer: Patho-
genesis, diagnosis, treatment, pathology, complica-
tions, including obstruction, hemorrhage, and per-
foration, gastric ulcer, surgery and jejunal ulcer.
Arrangements for a showing of the film may be
made by writing to the Professional Service De-
partment of John Wyeth and Brother, Inc., Phila-
delphia, who will provide projection equipment,
screen, film, and operator for medical groups,
without charge.
Book Review
The Care of the Aged — “Geriatrics”
By; Malford W. Thewlis, M. D., Attending Spe-
cialist, General Medicine, United States Pub-
lic Health Hospital, New York City; Attend-
ing Physician, South County Hospital, Wake-
field, R. L; Special Consultant, Rhode Island
Department of Public Health.
Fourth Edition, Thoroughly Revised.
With 50 Illustrations.
Published by The C. V. Mosby Company, St.
Louis, 1942. Price, $7.00.
The first edition of this book appeared in 1919,
the second in 1936, the third in 1941, and today,
the fourth edition goes forth to deal with the
problems of advancing years. Geriatrics is becom-
ing a specialty. It is being recognized today that
the ills of the aged are a special problem. This
book is well written and should be in the library
of every general practitioner of medicine.
The book is divided into four sections, namely:
General Considerations; Miscellaneous Geriatric
Problems; Specific Infections; Noninfectious Dis-
eases; Pathologic Conditions in Old Age.
Medical Queries Anstvered — Continued from page 228
iiosis is easily made solely on tlie basis of the
history. To bo sure, the electrocardiogram is
important in corroborating the clinical diag-
nosis of myocardial infarction and an electro-
cardiogram should be taken, if possible,
whenever the clinical diagaiosis of coronary
thrombosis is made. In my experience, the
electrocardiogram is most helpful in differen-
tiating between myocardial infarction and
pain of disease outside of the heart.
“I was most interested in your (Dr. Gott-
lieb’s) remark of normal electrocardiograms
in many cases of coronary occlusion. I pre-
sume that you are speaking from the patho-
logical standpoint wherein one frequently
finds coronary occlusions, single or multiple,
with little or no heart muscle damage. In my
experience, however, it is extremely unusual
not to find electrocardiographic changes in
individuals who clinically have suffered a
coronary occlusion, or better stated, myocar-
dial infarction, although such electrocardio-
graphic evidence may be at times several
■days or a week in making their appearance.
In the cases which you mentioned, did these
individuals give a history suggesting myocar-
dial infarction
238
The Journal of the Maine Medical Association
NINETIETH ANNUAL SESSION
Maine. Meaioai Aiiociaiien
POLAND SPRING, MAINE
JUNE 21, 22, 23, 1942
CONTINUED FROM THE SEPTEMBER ISSUE OF THE JOURNAL, PAGE 219
Chairman Stevens: The next report will be
that of our Delegate, Dr. Neil A. Fogg, of Rock-
land, to the Connecticut State Medical Society
meeting. Is Dr. Fogg here? If not, his report will
be received at a later time.
Next, we shall have the report of Dr. Forrest B.
Ames of Bangor, as delegate to the Massachusetts
Medical Society.
Dr. Forrest B. Ames of Bangor: Mr. Chairman
and Delegates. It is a fact that I have been a
member of the Massachusetts Medical Society
ever since I practiced there two years, when I
was beginning my medical work. I have retained
my membership. Therefore, when I was asked to
go again as an official delegate, I used the word
“again” because I did go once, many years ago,
I received that invitation with a good deal of
pleasure, and made my plans accordingly.
The meetings were held May 25th, 26th, and
27th at the Hotel Statler in Boston. Very inter-
estingly, they had the largest attendance of mem-
bers that they have ever had in the history of the
Society; that fact was commented upon, espe-
cially in view of the rather obvious fact that
already many of the members have gone into the
armed forces of the United States.
The meetings were crowded. The luncheons
had difficulty in serving those who came. They
had to bring in extra chairs for those who attended
the scientific sessions, and, all in all, the spirit of
enthusiasm and interest was very marked. It
showed that the Massachusetts Medical Society
was very well organized and that its members
did take a great deal of interest in their pro-
ceedings .
The scientific exhibit and the commercial exhibit
were also unusually large.
The annual meeting, which I attended, was
rather lengthy. For many months and perhaps
longer, a special committee had been working in
the Massachusetts Medical Society, revising their
by-laws. It seems that they haven’t printed these
for many years; in some cases, they needed to
clarify certain points, and there were a few points
of issue which came up and just prolonged the
meeting. One of them was of considerable interest.
It had to do with the admission into the Society
of the so-called foreign doctors who came from
other lands within the last few years. There was
considerable feeling about this, because some of
the men who had come from across were highly
trained and very well qualified, and the set-up
that was proposed was a five-year inteiwal of
licensure in the State, before they would be
allowed to become members of the Massachusetts
Medical Society.
Some of the men felt that would work a real
hardship on these alien, so-called, physicians, but
in the end the report of the Committee was
adopted, that this five-year term stand, and it
was so voted.
The chief emphasis of the whole meeting was
on the war. The scientific papers had to do with
problems concerning preparations for war, and the
problems of civilian defense and public health
were emphasized throughout all the different meet-
ings which were held.
When the time came to call on the State dele-
gates, and this is just a little selfish interpolation,
so to speak, it so happened that the delegate from
Maine was the only one who responded from all
of the New England states, and that was more
than a little pleasure to me, and of course I was
very cordially received by the officials and those
who were at the meeting of delegates.
At the annual banquet, over 500 were in attend-
ance, when, again, the members got some idea
of the type of talk that Dr. Lahey had already
given to some of the Maine doctors at Portland.
He spoke, I think, less vigorously, nevertheless,
just as emphatically about the need for enlistment
of our younger medical men, speaking somewhat
on the Procurement and Assignment end of it,
and in no uncertain terms, as Dr. Foster has
suggested he spoke at the A. M. A. meeting. He
stated that the needs are very vital, and the men
must realize that and respond.
Later, Dr. Fishbein spoke in a somewhat lighter
vein, nevertheless very seriously emphasizing the
medical situation throughout the country and
emphasizing the steps taken in different places to
meet the needs as they arose.
Following the banquet, again the congestion of
attendance was shown. We adjourned to the lec-
ture room in the hotel, and the meeting was de-
layed nearly three quarters of an hour while extra
chairs were brought in to take care of the large
attendance. It certainly was well worth while
going to that particular meeting.
The Shattuck lecture, which is an educational
institution with the Massachusetts Medical
Society, was given by Dr. John F. Fulton, Pro-
fessor of Physiology at Yale Medical School. He
took for his subject, “Medicine and Air Suprem-
acy.” He approached it from a most interesting
standpoint, and discussed, from the physiological
standpoint, the problems which are being attacked
in air medicine today, especially the effect of
high altitudes on the human body, and also the
reverse, the effect of crashes on the human body,
and, discussing those from the standpoint of
physiology in medicine, he gave us a most inter-
esting evening.
Dr. Fulton spoke rather casually of an army of
7,000,000 or 10,000,000 men in the country before
the thing is fully organized. He spoke almost as
casually, but very emphatically, of a force of
flight surgeons of over 20,000, emphasizing again
Nineteen Hundred and Forty-two — October
239
the need for enlistment of onr younger, able-
bodied physicians.
The scientific exhibits, I think, were, as usual,
somwhat a replica of those we have seen in past
years at the A. M. A., very nicely put on and very
ably presented. One that perhaps appealed espe-
cially to me was the Symposium Exhibit on Dis-
eases of the Biliary Tract, approached from dif-
ferent diagnostic methods, and including exhibits
of surgical methods, also.
Exhibits on the blood banks, of course, are of
vital importance to us in the State of Maine.
There were seventy-one technical exhibits,
almost too many to take in, but I wandered around
each of the two days and met many of the exhib-
itors, and the spirit of the whole convention was
that the commercial exhibitors were, as we have
found them in our own meetings, very much in
sympathy with the doctors and in cooperation
with them.
It was a very fine convention, far superior to
the one I attended many years ago as a delegate.
But, each year, it seems to me that the Massa-
chusetts Medical Society does seem to work more
as a unified group and, of course, a very large
group.
So I want to thank you very much for sending
me to Massachusetts. I enjoyed it very much, and
I got some ideas that, as time goes on, I think I
would like to have us follow in Maine in our own
way, which, of course, we would do in any event.
Again, thank you very much. [Applause.]
Chairman Stevens; Next, we shall have the
report of Dr. Carl E. Richards of Alfred, who was
our delegate to the New Hampshire' Medical
Society. Dr. Richards!
Dr. Carl E. Richards of Alfred; Mr. Chairman
and members of the House of Delegates. I had the
honor and the pleasure' of attending the New
Hampshire Medical Society meeting at the Hotel
Carpenter, Manchester, New Hampshire, on May
12 and 13, 1942.
The meeting was very similar to ours. In the
morning, there were conferences, and in the after-
noon, the scientific sessions and the lectures were
held. The subjects were well-chosen, and the
speakers were authoritative and very interesting.
As many of you know, the Carpenter is a com-
mercial hotel, very much like the Eastland Hotel
in Portland, and, consequently, the meeting does
not have the vacationland atmosphere that we
have at our Annual Meetings.
At their House of Delegates’ meetings, they
voted to contribute $1.00 for each member of the
Society to the National Physicians’ Committee.
The doctors’ wives in New Hampshire have an
auxiliary which i^ very active, and my wife went
with me to New Hampshire and attended their
meetings and the banquet, and they suggested
to her to have me offer the suggestion that pos-
sibly Maine should have a similar organization.
They have another interesting thing in connec-
tion with their meetings; I refer to the Annual
Contest, with Prize Essays, and with money prizes
for the best paper presented by men throughout
the State.
The prize for the essay on Surgery was given to
a man in Portsmouth, New Hampshire, Dr. Lium,
and I believe he is well known to the men in our
county, because he has been over to our Society
and talked to us.
The annual banquet was a very enjoyable affair,
and, all in all, I should like to say that the meeting
was of very high calibre, and I had a fine time.
I wish to thank you all very much for sending
me. [Applause.]
Chairman Stevens; Thank you very much.
Dr. Richards. At this time. Dr. Joseph E. Porter
of Portland will report as Delegate to the Rhode
Island Medical Society. Dr. Porter!
Dr. Joseph E. Porter of Portland; Mr. Chair-
man and members of the House of Delegates. I
am very grateful to you for the opportunity to
attend the Rhode Island Medical Society meeting.
It covered two days, June 3 and 4, 1942. The after-
noon meetings were held at the Rhode Island
Medical Library at Providence, which is located
about half a mile from the city, up near the State
Capitol.
The mornings were devoted to clinics.
I attended the clinics at the Rhode Island Hos-
pital. I listened to some very interesting discus-
sions there, and I was very much impressed by
the active, full-formed department of thoracic sur-
gery. I think their results have been very good,
comparatively good.
I listened, also, to a very interesting case pre-
sented by Dr. Lawson, and I point this out because
the particular patient was a known diabetic, went
into insulin shock, and had the lowest blood sugar
I have ever seen.
The next morning I went to the Chapin House
and watched a very well illustrated presentation
of Diseases of the Chest. Following this, they
showed a film, a colored movie, which lasted an
hour, and it was a film on contagious diseases.
I certainly would recommend that if anyone could
get that film in the State of Maine, it would be very
much worth while, since I think the facilities and
the hospitalization are something to be desired at
the present time.
During the afternoon session, the principal
speaker was Dr. Chester Keefer of Boston; he
spoke on the subject of Gramicidin, and that is
something that I have wanted to hear about for
a long time. The material is derived from the
fungus pencitilium and also from other bacteria,
and this substance does have the power of killing
gram positive bacteria.
In the evening, I listened to a well-illustrated
paper on “Arteriosclerosis” by Timothy Leary,
and other papers.
At the banquet, the principal speaker was a
barrister from London, who compared Hitler with
Napoleon.
The meeting, in general, was very much lacking
in any discussion of a war-like character. In fact,
I can’t recall any papers that dealt particularly
with war surgery or the handling of war casualties.
It might be interesting to note at this particular
time that I spent an hour one day talking with
Dr. Knight, who is head of the Milk Inspections
Department there. The reason I am bringing this
up is in view of the discussion we had this after-
noon on the milk situation. They do have a law
there which requires milk to be pasteurized before
it is sold, but the problem doesn’t end there.
Apparently, they have to carry out very rigid
tests on the milk, to be sure it is pasteurized,
because they are always catching dairymen down
there who are selling milk that is alleged to be
pasteurized and is not. He told me the best test,
out of numerous tests, was to determine the phos-
photase in the milk. If the phosphotase is still
present, it means it is not pasteurized. In other
words, it is not destroyed. Then they come in
under the Public Health Department, not the
Agricultural Department.
I enjoyed my trip to Providence very much,
because I was born there and I had the chance to
renew many old acquaintances there.
Thank you very much.
Chairman Stevens; Thank you. Dr. Porter,
for that fine report.
240
The Journal of the Maine Medical Association
Dr. Harry Butler of Bangor, our delegate to
Vermont, was unable to be present because of his
duties, but his report will be printed in the
.ToX'RNAL.
The next order of business will be the reports
of Standing Committees that were not published
or not submitted for publication in the June issue
of the Journal.
The first Committee is the Committee on Medi-
cal Education and Hospitals. Dr. Adam P. Leigh-
ton of Portland, Chairman of this Committee, has
notified us that he is unable to be here today, but
will be here tomorrow.
The next Committee is the Committee on Social
Hygiene, and Dr. Benjamin B. Foster of Portland
is Chairman of that Committee. Dr. Carter has
the report of Dr. Poster, which he will read to us
now.
Secretary Cartier ; Dr. Foster wrote me a let-
ter under date of April 28, 1942, as follows:
“Due to the loss of one of the members of the
Committee on Social Hygiene, Dr. Merrill of Ban-
gor, I have not called a meeting this year, and
have no yearly report to offer. (Signed) B. B.
Foster.’’
Chairman Stevens: Next is the report of the
Publicity Committee by Dr. Carter.
Secretary Carter: Mr. Chairman, the publi-
city relative to the activity of the Association, the
Fall Clinical Session and our Annual Meeting, has
been prepared in our office and sent to the news-
papers for release. They have been very coopera-
tive and kind, and have printed anything that we
have sent to them.
Dr. Thomas A. Foster: Mr. President, I would
like to rise again to say that I think the report
published in the Portland paper last Sunday about
the meeting is one of the best reports I have ever
seen, and I would like to congratulate the Com-
mittee on Publicity for the newspaper publicity
we have had for this meeting.
I repeat that I think that was a splendid presen-
tation of the coming meeting.
Chairman Stevens: The next report is that of
the Financial Advisory Committee, by Dr. George
L. Pratt.
Dr. Pratt: I would like to say that this report
will be deferred until tomorrow.
Chairman Stevens: We have next the reports
of special committees not submitted tor publica-
tion in the June issue of the Journal. The first
report will be that of the Tuberculosis Committee
by Dr. Edward A. Greco of Portland.
Secretary Carter: Dr. Greco telephoned that
he would be unable to be here today, but that he
would give his report tomorrow.
Chairman Stevens; The next report will be
the report of the Committee on Maternal and
Child Welfare by Dr. Roland B. Moore, Chairman.
Is Dr. Moore here? [There was no response.] Dr.
Moore is not here. We may be able to secure his
report later.
The next report will be that of the Committee
to Secure Hospital and Medical Care, by Dr. Judd
Beach, Chairman of that Committee.
Dr. S. Judd Beach of Portiancl: Mr. Chairman
and members or the House of Delegaies. This re-
port which I am submitting is the report of a vol-
untary Committee, composed of Dr. Foster and
myseli, who have done some work on this subject
and have interviewed Dr. McCann, who is the
Chairman of the Massachusetts Committee on Pre-
paid Medical Service. It has been authorized by
mailed vote of the Committee, which has not met
this year. The report is as follows:
The sponsors of Federal Compulsory Health In-
surance have caused anxiety in the Medical Pro-
fession by introducing into Congress a plan for
prepaid hospital service. If this is, as it appears,
tke entering wedge for a general plan for state
controlled prepaid medical care, physicians should
awake to the danger that they may find them-
selves entangled in a bureaucratic scheme.
The present emergency with its shortage of phy-
sicians offers a fruitful ground for visionary wel-
fare projects. Your Committee feels that the best
answer to the impractical propositions that have
from time to time been suggested, is for physi-
cians to offer a better counter-proposal.
After studying various plans that have been
tried, it finds the one most likely to fit this area
to be that of the Massachusetts Medical Society.
We would respectfully suggest that the Council
investigate this plan.
Dr. J. C. McCann, Chairman of the Massachu-
setts Committee, has agreed to explain it. We feel
that it is of sufficient importance to warrant a
special Council meeting for this purpose.
I am not submitting any detail in connection
with this because I don’t want to burden the
House of Delegates with all of our investigations.
But, if there are any questions regarding this,
either Dr. Foster or I would be very glad to
answer them.
Dr. Thomas Foster: May I have the honor of
speaking again? I don’t want to take the ffoor too
much. I have had an interest ifi this subject
which Dr. Beach brings before you.
When I was President, I asked the Council for
permission to appoint a special committee to in-
vestigate hospital and medical care of the citizens
of the State, and they unanimously gave me that
permission, and a committee was appointed, con-
sisting of one doctor in each district. The Com-
mittee had some meetings in which the purposes
and aims of the Committee seemed to be rather
vague, but the purposes and aims of the Commit-
tee boil down to the subject which Dr. Beach has
presented to you, the possibility of the Federal
Security Board, through the influence of Mr. Osni-
meyer, securing Federal Legislation of a compul-
sory medical nature for health care.
As Dr. Beach said, we talked to Dr. McCann,
who has introduced the subject to the Massachu-
setts Medical Society, where it has met with com-
plete approval. The Massachusetts Medical Soci-
ety voted him $25,000 deposit against the success
of the plan, and that is 25,000 cold dollars they
took out of the Treasury to deposit in the Insur-
ance Commissioner s office in a bank, to meet the
needs of his prepayment medical plan on partial
coverage lor the low income group.
As Dr. Beach said, we have met with Dr. Mc-
Cann and we had a long discussion with him, and
we, with others, believe that the Federal Security
Board are definitely committed for a Federal Plan
of Medical Care. He believes, and Massachusetts
apparently believes, that the best way to counter-
act that proposal is to have a plan or their own.
VVe were so impressed with Dr. McCann, in our
conversations witn him, that we thought it would
be beneiiciai lor this btate Society to invite Dr.
McCann to speak beiore a special meeting of the
House of Delegates. It seemed unwise to ask him
to come to a stated meeting, because the time is
so short, and so many things needed to be done.
The program covers so much time that it leaves
little time lor special considerations. This matter
needs special consideration.
1 think we were entirely sincere in proposing
that this House of Delegates consider the advisa-
bility of a special meeting to hear Dr. McCann
explain his plan, now accepted and adopted in the
State of Massachusetts.
Dr. S. Judd Beach: May I add a word to what
Nineteen Hundred and Forty-two — October
Dr. Foster has said? I do not know whether yon
people know who Dr. McCann is. He is the son of
Dr. McCann of Bangor, practicing there a gi’eat
many years, and a member of this Society. He
has a great interest in the State. I think that is
one of the reasons why he is willing to take the
time to speak about this project.
I don’t know whether the House of Delegates is
aware of the number of plans that have been tried
in various parts of this country, but there is a
plan in California, as you know, and one in Michi-
gan, and several, I think, in New York and New
Jersey. All of them have been tried, and have had
some reason why they were not entirely success-
ful. Some of them have been very expensive, as a
matter of fact, for the Societies, and the informa-
tion about these plans is almost impossible to ob-
tain. You can write to the A. M. A. and find out
absolutely nothing about them. They will give
you encouragement to carry out any plan you
want to, but they have no material on which you
can work.
I believe I wrote to all of the sponsors of these
plans, and got their material, and I have gone
over it carefully, and found the same thing that
the Massachusetts Committee has found; that is,
that they are apparently not adapted to our par-
ticular needs.
Now, the difference between the Massachusetts
Plan and these other plans is that it is a partial
covering plan, and one that looks as if it might
have some prospect of being carried through with-
out breaking the medical society or the medical
profession. I don’t think it is worth while to take
the time of this House of Delegates to go into the
details of these other plans. Yet, I think it would
be well worth while to get Dr. McCann, who has
all of this material at his finger tips, to give this
information to the House.
Dr. Forrest B. Ames: I met Dr. McCann in
Massachusetts. I knew him when he was in Ban-
gor. He is a fine young man. But here is one
paragraph taken from the Massachusetts Medical
Society program, which I will read to you:
“The first contract will cover hospital, obstetric,
diagnostic, x-ray and surgery, including ortho-
pedics.”
In other words, it begins with one little group.
“Later on, the contract Avill cover all hospital
medical expenses that ha^m developed.
“Finally, the contract will cover medical care
expenses, hospital, home and office.”
Now, that is just a basic statement, and I
thought from their little pamphlet that you might
be interested in it.
241
Chairmax STEAmxs: Are there any other com-
ments, or aii5" action that anyone wishes to take
concerning this subject?
Dr. Cobb: I might say that this was brought
up before the Council, and Dr. Pratt was appointed
by Dr. Ebbett to look into this thing. The first
thing AA'e have to have is $10,000 to deposit with
some insurance company. AVe haven’t got it. This
matter was tabled for the duration.
Dr. Pratt: I would like to say that I tried to
get some information on this subject, and I got the
most of it from Dr. McCann, who, I think, knoAVS
more about the matter than anyone else that I
know of. I also got some information out of the
Michigan Plan and the Pennsylvania Plan. I think
they all feel that if they are not going to be ruined
financially, they have to start out with a limited
coAmrage plan.
It Avould seem to me that before we started on
anything, I would like to hear from Dr. McCann;
I AA’ould like to hear him talk to the Delegates.
But before we start on anything, it seems to me
there are three questions Ave should answer to
make up our minds about it.
The first one is Avhether we Avant to start it dur-
ing the war emergency. We AAmuld get opinions on
both sides of that question, perhaps.
Secondly, are Ave prepared to put up from $7,000
to $10,000 to start with, because if we followed
the Massachusetts Plan, AA'e are acting as an in-
surance company, and Ave would be under the
superAusion of the Commissioner of Insurance.
Third, and the most important and perplexing
question is this. What would we do about the
osteopaths?
Chairmax Stevexs: Thank you. Doctor. As I
understand it, this matter, as Dr. Cobb said, was
tabled for the duration in the Council. However,
I Avish to gWe the members of this House of Dele-
gates an opportunity to express themselves if they
care to do so at this time.
Dr. Carl Richards; It seems to me that if the
administration in Washington is going to put o\"er
any social security plan on us, they are going to
do it during this emergency, and I should think
we ought to be making some plans to take some
steps at the same time that they are making theirs.
It certainly seems that we could have Dr. Mc-
Cann up here, either to a Council meeting or to a
meeting of the House of Delegates, and then Ave
could find out what it is all about, and then Ave
could talk it oA-er and discuss it and see if we
couldn’t at least make tentatWe plans.
I don’t believe it is a good idea to table such an
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242
The Journal of the Maine Medical Association
important matter as this, for the duration. We
haven’t any idea of the length of the war, or how
much legislation will be foisted upon us during
the emergency.
Another thing, we are probably to go into the
service — that is, a great many of the younger men
like myself — and we will be away for the duration
and we won’t have a chance to say very much.
I think that the House of Delegates should hear
Dr. McCann; in fact, I will make a motion that
the House of Delegates go on record as favoring
having Dr. McCann come to Maine and meet with
either the Council or the House of Delegates and
explain this whole plan to us, very shortly.
This motion was duly seconded by several of the
members present.
Dr. Put mmer: I haven’t heard all that was
said, but I am a new man here, so perhaps I
would like to get some information. I don’t think
it is any more our business to have anything to
do with an insurance plan, or with people paying
their bills at the hospital, than it is to start a
fire insurance company.
If anybody wants to insure anybody else, if any-
body wants to organize a company and insure
them, that it all right with me. It is all right
with me either way. But I don’t consider it is any
of our business at all. We are not in the insur-
ance business, and that is truly what it would
mean.
We cannot collect our own hills, and we have
got to see what can be done about that as best we
may do so, individually. But I would say it is
none of the Society’s business whether I collect
my bills or not, or whether Dr. Pratt or any other
doctor collects his fees; that is his business.
I have no objection to listening to Dr. McCann,
but I think one great difficulty with the country
as a whole, and I would like to interject this here
without raising any political question, because a
lot of this stuff didn’t start with Roosevelt when
he was inaugurated in 1933 but it had been gath-
ering momentum for a good many years before;
I would like to make the statement that I think
when it gets so that the government not only of
the State of Maine and the United States will tend
to its own business and we will attend to ours as
best we can, we will be better off, and we may
begin to get somewhere.
Chairman Stevens; Is there any further dis-
cussion?
Dr. Raymoxd E. Weymouth of Bar Harbor: As
I understand this motion, it is not a motion
whereby we may hope to collect our bills, but it
is a motion whereby we may hope to have some
bills to collect and not be on a salary.
Dr. Jameson: I would like to suggest that the
motion be definitely in favor of having Dr. Mc-
Cann address the House of Delegates rather than
the Council, because I think the matter is one of
great interest to a much larger body than the
council; therefore, I would like to have that mo-
tion crystallized into an invitation to appear be-
fore the House of Delegates rather than the Coun-
cil. I should like to amend the original motion
and suggest that it be specified that Dr. McCann
come to Maine to speak before the House of Dele-
gates.
Dr. Richards: I will accept that amendment.
Chairman Stevens; Those in favor of the mo-
tion, as amended, will please signify by raising
your right hand. Those opposed?
The motion was carried by a hand-raising vote.
Chairman Stevens; The next order of busi-
ness is a report of the Committee on Industrial
Health, by Stephen Cobb.
Dr. Cobb: Mr. Chairman, I would like to say
that the Council on Industrial Health is a function
on paper only. We are planning to have a meet-
ing at twelve o’clock tomorrow, and if any of you
gentlemen are interested in industrial health, you
are invited; I may have something to report then.
Chairman Stevens: The next order of busi-
ness is the report of the Committee on Conserva-
tion of Vision. Dr. Kershner is not here, but the
report will be given by Dr. Carter.
Secretary Carter; I received a letter from Dr.
Kershner as follows;
“In reply to your letter of June 15, will say that
the Committee has just been appointed, and will
lay out their program of work at a meeting either
on Monday or Tuesday. The only report that could
be made now is that the Glaucoma problem will
be the first subject of attack and consideration by
the Committee. I hardly think it is necessary to
even report that at the present time.”
Chairman Stevi;ns; Is there any new busi-
ness to come before the House of Delegates at this
time?
Secretary Carter: Mr. Chairman, I would like
to call the attention of the House of Delegates of
the First, Second and Third Districts that tomor-
row they will be required to appoint a Councillor
from the First District to take Dr. Cobb’s place,
as his term expires in 1942; also the Second Dis-
trict, to nominate someone in Dr. McCarty’s place;
and also the Third District, as you know Dr. C.
Harold Jameson was appointed by the Council for
the remainder of this year until the House of
Delegates could fill Dr. Ellingwood’s place. I
would ask that you have your appointments ready
for tomorrow.
Chairman Stevens; Is there any other busi-
ness to come before this meeting? If not, a motion
is in order to adjourn until tomorrow at five-
thirty.
Dr. Ames: I move that we adjourn until to-
morrow at five-thirty.
This motion was duly seconded and was carried.
[Adjournment at 7.00 p. m.]
Continued in the November Issue
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The Journal
of the
Maine Medical Association
Uolume Thirti^^three Portland, Ulaine, Nouember 1942 No. 11
The Work of the Bingham Associates Fund in Maine"^
Bv Joseph H. Pratt, f\L I)., Sc. D., Boston, Massachusetts
Medical education is a life-long affair.
When a physician ceases to he a student, he
does not stand still, he slips backwards and
deteriorates intellectually. Some
cease to he students when they finish their
course of study in the medical school.
Throughout their professional life which may
cover a span of thirty or more years, the
stream of medical progress moves swiftly on,
but instead of moving with the current, these
men crawl up on the hank. Years ago the
widow of a physician gave me her husband’s
medical library. He, unlike the majority of
medical men of his generation, had the ad-
vantage of a college education before taking
up the study of medicine. Graduating from
Harvard about 1840, he probably had as good
a training as was then available in this coun-
try. Although he practiced medicine about
forty years, the publication date of prac-
tically all the hundred or more books I ac-
quired was prior to his graduation. During
the last quarter century of his professional
life, he aj)parently never added a book to his
library. This was no exceptional case, I am
sure, and doubtless could be duplicated many
times in modern davs.
The Committee on Graduate Education of
the Maine Medical Association, of which Dr.
Frederick T. Hill of AVaterville is chairman,
sent a questionnaire to every member of the
Association. From a study of the replies. Dr.
Hill concluded that while 25% are continu-
ing their education satisfactorily by means of
independent study with or without the aid of
graduate courses, 25% are too far advanced
in years to be expected to respond to the ap-
peal of new knowledge and another 25% are
indifferent, seemingly quite beyond being
awakened from their lethargic state by any
means at our command. The remaining
25%, Dr. Hill concluded, have possibilities
and if given opportunities and encourage-
ment to continue their education would
probably do so to their gueat benefit and to
that of their patients. In this committee’s
questionnaire, the reason was asked for not
attending medical meetings and for not tak-
ing graduate courses for which the Common-
wealth and the Bingham Associates Fund
offered fellowships. Sample answers to this
([uestion quoted by Dr. Hill are illuminat-
ing: ^ffoo busy,” “lack of time,” “practice
too large to leave,” “no need for it.” Here is
* Presented at the Second New England Institute for Hospital Administrators, June 20, 1942, in
Boston.
244
one who thinks highly of himself ; ‘^as a coun-
try doctor I feel I know more than many of
the so-called big clinicians who would teach
us. Give me the facilities and I will rewrite
Osier.” One reason for not taking graduate
courses at a distance from home doubtless
held by many was expressed by one as fol-
lows ; “Some of my good patients have been
lost to other doctors when I was away and
they keep them, also get the appendix out of
some.” Dr. Hill’s comment is “Change ap-
pendix to tonsils and, I fear, the statement
applies to otolaryngology.”
Much has been done during the past ten
years and more can be done in the State of
Maine to aid physicians continue their self-
education. It is an encouraging fact that the
survey of Dr. Hill’s committee shows that no
less than 50% is eager or at least willing to
avail themselves if opportunities are offered.
Eleven special opportunities available in
Maine for the continuing education of the
physician are as follows :
I. The hospital extension service spon-
sored by the Bingham Associates
Fund.
2. The staff meetings of the local hos-
pital.
3. The meetings of the County medical
society.
4. The clinics and demonstrations by
visiting physicians in local hospitals.
5. Weekly and monthly courses at the
Joseph H. Pratt Diagnostic Hospital.
6. The diagnostic study of cases at the
Joseph H. Pratt Diagnostic Hospital.
7. The monthly clinical days at the Cen-
tral Maine General Hospital con-
ducted by distinguished visiting-
clinicians.
8. The Gerrish Memorial Library at the
Central Maine General Hospital,
Lewiston.
9. The Bulletin of the Hew England
Medical Center issued bimonthly.
10. The meetings of the Maine Medical
Association.
II. Commonwealth Fund fellowships.
It was the desire in the heart and mind of
William Bingham 2nd that the sick people in
The Journal of the Maine Medical Association
the smaller towns and villages of Maine
should have the best possible medical care
that led him to found in 1931 the Bingham
Associates Fund. He recognized that the
small hospitals should have proper facilities
and that opportunities for continuation edu-
cation should be provided for the members of
the staffs of these hospitals. Members of the
medical profession of Maine have shown keen
appreciation of Mr. Bingham’s efforts and
have given his work hearty support. Under
the supervision of its president. Dr. George
Bourne Farnsworth, the Bingham Associates
Fund has cooperated with the hospitals in
building up mutual organization in Maine
for hospital care and the continuation educa-
tion of physicians which is already accom-
plishing much good. The plan is one of de-
centralization. It recognizes that the small
hospital can be made the most important
factor in the education of the physician as
well as in the care of the sick. As Dr. John
C. Leonard has said, the size of a hospital is
no criterion of the value of the service it
renders. Through the hospital extension
service of the Bingham Associates, thirteen
of the small hospitals in Central Maine have
become affiliated with the Central Maine
General Hospital at Lewiston, and eleven
hospitals in Eastern Maine with the Eastern
Maine General Hospital at Bangor. The fol-
lowing is a list of the hospitals :
Bangor Group:
Eastern Maine General Hospital, Bangor.
Waldo County General Hospital, Belfast.
Castine Community Hospital, Castine.
Blue Hill Memorial Hospital, Blue Hill.
Mount Desert Island Hospital, Bar
Harbor.
Washington County Hospital, Machias.
Lubec Hospital, Lubec.
Aroostook Hospital, Houlton.
Calais Hospital, Calais.
Milliken Memorial Hospital, Island Falls.
Charles A. Dean Hospital, Greenville.
Mayo Memorial Hospital, Dover-Foxcroft.
Lewiston Group:
Central Maine General Hospital, Lewiston.
Brunswick Hospital, Brunswick.
Bath Memorial Hospital, Bath.
245
Nineteen Hundred and Forty-two — November
St. Andrew’s Hospital, Boothbay Harbor.
Miles Memorial Hospital, Damariscotta.
Knox County General Hospital, Rockland.
Camden Hospital, Camden.
Augusta General Hospital, Augaista.
Sisters’ Hospital, Waterville.
Tbayer Hospital, Waterville.
Redington Memorial Hospital, Skowbegan.
Franklin County Memorial Hospital,
Farmington.
Rumford Community Hospital, Rumford.
St. Mary’s General Hospital, Lewiston.
Dr. J. C. Hiebert in his recent presiden-
tial address before the New England Hos-
pital Assembly commended the work of the
Bingham Associates Extension Service and
pointed out that “certain special services will
never be available in the rural areas unless
larger hospitals help the smaller institutions.
It has now been well demonstrated that it is
possible for hospitals to work together in
order to supplement one another’s services,
especially in the X-ray and laboratoiy depart-
ments.” This statement was based on his ob-
servations and experience as superintendent
of the Central Maine General Hospital. The
plan of the Bingham Extension Service was
designed and directed by Dr. Samuel Proger,
professor of clinical medicine at Tufts. This
he has described in detail in two excellent
papers. Dr. D. Allen Craig, medical director
of the Eastern Maine General Hospital, has
had general charge of work in the Bangor
District and Dr. Everett L. Higgins, chief of
the medical staff of the Central Maine Gen-
eral Hospital, is the president of the Central
Maine Bingham Associates Eund Committee
through which the extension services to small
hospitals from a large hospital as a regional
center was set up and carried out.
The two regional centers in Lewiston and
Bangor in turn are affiliated with Tufts Col-
lege Medical School and the New England
Medical Center.
The hospital extension service provides :
a. Pathological examinations for all of
the twenty-four affiliated small hospitals.
b. Interpretation of X-ray films and fluo-
roscopic examinations.
c. The training of technicians in clinical
chemistry and clinical microscopy.
d. Interpretation of electrocardiograms.
e. Support of the Gerrish Memorial Li-
brary at the Central Maine General Hospital
which enables it to send books and journals
regailarly to the affiliated hospitals and on re-
quest to any physician in the State of Maine.
f. Courses in dietetics given at the New
England Medical Center.
g. Teaching ward rounds given at five of
the hospitals during 1941.
h. Postgraduate courses given in Boston
in medicine, electrocardiography, ophthal-
mology, otolaryngology, surgery, and clinical
chemistry for technicians. In all, thirty
courses were given in fifteen subjects in 1941.
The total enrollment for the year was 128.
Bingham fellowships were given to fifty-one
Maine physicians.
Pathology. The pathologists at the East-
ern Maine General Hospital and the Central
Maine General Hospital examine tissues re-
moved at operation in all the twenty-six hos-
pitals in their regional districts. Many
specimens presenting unusual features or dif-
ficulties in diagnosis are referred to Dr. H.
E. MacMahon, professor of pathology at
Tufts Medical School. During 1941, he
examined at least one thousand slides referred
to him from the Central Maine General Hos-
pital, and one hundred and seventy-five from
the Eastern Maine General Hospital. In
addition. Dr. MacMahon studied microscopic
specimens from thirty autopsies sent him
from the Lewiston Hospital. He holds fre-
quent seminars which are attended by the
Maine pathologists. It is thus seen that every
physician referring patients to any one of the
twenty-six affiliated Maine hospitals has the
benefit of the services of expert pathologists.
Roentgenology. Dr. Eorrest B. Ames, the
roentgenologist of the Eastern Maine Gen-
eral Hospital, holds frequent X-ray confer-
ences which are regularly attended by the
physicians who do the X-ray work in the
small hospitals of that region. During the
year 1941, over 6,000 films were examined
and in addition he made 38 visits to the aifi-
246
liated liospitals. I)r. lioland Clapp of the
Central Maine Greneral Hospital visits regn-
larly all the affiliated hospitals in the Lewis-
ton district and makes flnoroscopic examina-
tions in selected cases. In 1941 he held 2,808
X-ray consultations in this group of hos-
pitals. Both roentgenologists are enabled by
Bingham Fnnd fellowships to attend the
weekly X-ray conferences at the Massa-
chusetts General Hospital.
Training of technicians. Hr. Jnlins
Gottlieb, pathologist at the Central iMaine
General Hospital, has a flonrishing school for
the training of medical technicians which
231’ovides the affiliated hospitals workers suf-
ficiently skilled in clinical pathology and
chemistry to make trnstworth}^ reports to the
hospital physicians. The technicians return
each year for one month’s additional instruc-
tion at the Pratt Diagnostic Hospital. They
do this with the aid of Bingham scholarships.
An itinerant technician is provided to sub-
stitute for the technician who is taking the
course. ^‘Last year, the head of onr Chemis-
try Laboratory at the Pratt Hospital, i\Ir.
Joseph Benotti, inspected the laboratories in
the hospitals at Portland, Lewiston, Brnns-
wick, Bath, Angnsta, Bangor, Skowhegan,
and Waterville, and gave advice and instrnc-
tion to the technicians on the utilization and
care of equipment and made suggestions for
improvements. It was ]iot primarily a
teaching tonr, but a good deal of informal
teaching was done, and in Bangor a lecture
for technicians was given.” Proger.
Lihrary Aid. The Gerrish Memorial Li-
brary at Lewiston receives 125 journals
which it distributes to regional hospitals in
the Lewiston district. Each coinmnnity hos-
pital receives from the library five medical
journals where they remain prominently dis-
played for four days, after which they are
forwarded to another hospital of the group
and new ones are received. The plan has re-
ceived enthusiastic cooperation among the
participating hospitals, and many libraries
may well envy the record of ]iot one journal
lost during the year, although most of the
journals have been consulted by many staff
doctors. In the course of a month, each hos-
The Journal of the Maine Medical Association
pital receives thirty-five medical journals.
During a whole year, the number of l)ooks
and journals loaned by this library service
has increased from 3,810 in 1940 to 7,735 in
1941. The library had a large collection of
reprints of recent important papers and sup-
plies bibliographical material to any Maine
physician who wishes to review the literature
with reference to any special case or to pre-
pare a paper for presentation at a medical
society or for publication. This service is
rendered promptly. One day while staying at
Bethel, I was asked to see a case at the Rnm-
ford Hospital of suspected lupus erythema-
tosus disseminata. Being unfamiliar with
this rather rare disease, I telephoned the
librarian at Lewiston for recent literature
and the evening of the same day, received
half a dozen books and journals containing
articles dealing with it. The Gerrish Library
has an institutional membership in the Bos-
ton Medical Library and is able to obtain the
loan of books and journals from its great
collections.
Electrocardiography. Xearly all the hos-
pitals have electrocardiographs and during
1941 no less than 357 electrocardiograms
were submitted to the cardiologists. Dr. W.
J. Conieau of Bangor and Dr. L. W. Steele
of Lewiston, for interpretation. Dr. Comeau
held 20 electrocardiographic conferences in
Bangor following the regular X-ray confer-
ences. Dr. Steele held 110 consultations with
doctors in the Lewiston region. They in turn
send about a dozen unusual tracings to Dr.
Proger in Boston. If they present puzzling
features, he consults with Dr. P. D. White,
Dr. S. A. Levine, or other experts. Thus any
patient with heart disease in any of the affi-
liated hospitals has this diagnostic service
which is helpful to the patient and instruc-
tive to his doctor.
Details regarding the various courses given
at the Xew England Medical Center and the
Diagnostic Hospital will be found in Dr.
Proger’s papers. For these courses, Bingham
fellowships have been available to Maine
physicians. They have served to establish
cordial relations between the doctors who at-
tended them and the members of our staff.
The instruction is largely in the form of
Nineteen Hundred and Forty-two — November
clinical lectures and demonstrations. As Dr.
F. T. Hill truly observes that of necessity
“this type of education is a form of spoon
feeding. It’s all right as a starter — as an in-
centive, but does not compare with the best
type of education which is self-education.”
The work of the Diagnostic Hospital how-
ever aids the self-education of the referring
doctor. To it puzzling cases are sent for
diagnosis and suggestions for treatment. A
diagnostic ward in the Hew England IMedi-
cal Center was equipped by the Bingham
Associates Fund in the fall of 1931 and this
service has steadily grown since then. A hos-
pital for diagnosis evidently filled a real need
and doctors in increasing numbers availed
themselves of the opportunities it offered.
The patients were returned in a few days to
the doctors who had referred them and the
treatment was left in their hands. The physi-
cian-|)atient relationship was strengthened,
not weakened, by the stay in the diagnostic
hospital. More and more patients were re-
ferred for diagnosis and in the course of a
few years the accommodations were overtaxed
and it was necessary to place at times even
acutely ill patients on a waiting list. This
was disturbing and tended to limit the use-
fulness of the services rendered. This diffi-
culty was overcome when in 1937 Mr. Bing-
ham gave funds for a splendidly designed
and equipped hospital, so planned as to pro-
vide eventually for 100 beds. This hospital,
of which Mr. Bingham was sole donor, cost
nearly three-quarters of a million dollars and
should have been named for him. But witli
self-effacing modesty that is characteristic, he
would not allow it to be called the William
Bingham Diagnostic Hospital, which was the
wish of all, but insisted instead that it bear
my name. This hospital with complete labor-
atories and every facility for diagnosis was
opened in December, 1938. It is a unit of
the Hew England Medical Center. Over
1,000 physicians have referred cases since
the diagnostic hospital was opened three and
a half years ago. The average stay of patients
in the hospital is only 4 or ,5 days. They
then return to their home. The referring doc-
tor is furnished a detailed report of the re-
sults of the examinations. Abstracts of cur-
rent literature dealing with the disease with
247
which the patient is afflicted are also sent to
the physician. These abstracts are prepared
with especial reference to methods of diag-_
nosis and treatment. Over 150 of these re-
cently prepared abstracts are on file. Each
abstract gives references to selected articles
as a help and encouragement to the physician
to study the subject further.
The Bulletin of the Hew England Medical
Center contains summaries of lectures and
papers presented at the daily conferences in
the Diagnostic Hospital by leading Boston
physicians as well as members of our staff. It
also contains clinical reports and short arti-
cles on diagnosis and treatment. This pub-
lication has a circulation of about 5,000
copies. It is sent to all physicians who take
graduate courses at Tufts or refer patients to
the hospital.
In the early part of this paper the impor-
tance of the small hospital in the education
of the staff as well as in the care of the pa-
tient was emphasized. The facilities now
available in small Maine hospitals are excel-
lent. One thing is lacking and that is good
medical records. The roentgenologist, the
pathologist, and the electrocardiognapher,
and the technicians in the laboratory all write
adequate reports, but the same cannot be said
of the physicians whose bedside examinations
are the most important of all. Too much im-
portance is attached to laboratory and H-ray
aids to diagnosis. A good history and physi-
cal examination excel them in value. Fried-
rich Muller, one of the greatest physicians of
modern times and a pioneer in clinical chem-
istry, told the truth when he said a physi-
cian’s percussion finger was worth more than
a whole chemical laboratorv. I am told that
some of the hospitals with whom the Bing-
ham Associates are affiliated have only nurses’
notes, in lieu of proper clinical records. If
true, this is a most serious defect and one
that should be corrected without delay. In
the June number of the Jouexau of the
Maixe Medical Association!, the leading
article deals with this timely topic. The
author is Miss Pearl R. Fisher, superin-
tendent of the Thayer Hospital in Materville.
It is entitled : “Records : The Problem of
Every Hospital.” A more apt title, she says,
would be “The Headache of Everv Hos-
V
248
The Journal of the Maine Medical Association
pital.” She points out that this ailment exists
to some degree in all hospitals and the cure
lies in the development of a record-conscious
staff, and adds that the utilization of hospital
records for teaching purposes by the staff has
an “amazing therapeutic effect.” The paper
contains much of value.
How can this pressing problem be solved ?
In the first place its solution would be
hastened if trustees of every hospital should
require a signed pledge of all physicians be-
fore receiving an appointment to the staff to
keep the medical records of their patients up
to the minimum standards established twenty-
four years ago by the American College of
Surgeons. A medical records committee
should be appointed and it should be the duty
of the chief of staff to see that this committee
is active and efficient. It should review all
records regularly, preferably weekly, and
promptly refer back unapproved records to
the responsible physician. MacEachern says
the practice is increasing of having the at-
tending physician sign a statement reading
as follows : “This is to certify that I have
carefully reviewed the attached record. Hos-
pital Ho. — , and to the best of my knowl-
edge, I find it accurate and complete.”
In order to obtain the enthusiastic coopera-
tion of the staff in this important matter,
medical records must be used. If they are
filed away uncorrected and never consulted,
it is easy to realize that the staff physicians
have some reason to regard the labor of pre-
paring them as largely a waste of time. The
staff meeting is the place where the records
can best be utilized. These meetings if prop-
erly planned can be most instructive as good
records have great teaching value and invite
comment and discussion. Dr. F. T. Hill in-
sists that staff meetings should be held weekly
throughout the year if the mental activity of
the staff is to be maintained at a high level.
We all learn more from our failures than
from our successes. At the staff meetings,
errors should be pointed out tactfully. A few
years ago, I attended a staff meeting at a
small hospital not many miles from Boston.
One of the staff members reported a fatal
case. It had been inadequately studied and
the physician in his discussion made state-
ments regarding diagnosis and treatment that
any good fourth-year medical student would
have known to be false. He sat down and no
one corrected his glaring errors. Afterwards,
I asked one of the staff if silence meant
assent. He replied, “Of course we know bet-
ter, but the speaker is sensitive and we didn’t
wish to hurt his feelings.” If such an atti-
tude of mind prevails, the staff meeting will
have no educational value. In fact it will
promulgate error instead of truth. Unless
mistakes in records are corrected by an im-
personal appraisal, such an occurrence at staff
meetings as the one I have related cannot be
uncommon.
The auditing of the medical work seems to
be the best method of improving both the
clinical knowledge of the staff and the quality
of the medical records. As an example of its
life-saving value. Dr. Howard M. Clute cites
his experience at the Massachusetts Memorial
Hospital where the mortality in gall-bladder
surgery has fallen in the “last few years from
8% to 5% to 2% and last year to 0%.”
The high mortality revealed by the audit
aroused the staff to the need of better work.
Every case was discussed by several of the
staff before operation and special measures
were adopted for the pre- and post-operative
care. Although the general staff continued to
do the surgery, one man was given the re-
sponsibility of following the cases and report-
ing the complications and failures. The bril-
liant success achieved was due to the willing-
ness of the staff to have mistakes of each
member revealed.
Miss Fisher states that at the Thayer Hos-
pital, Waterville, the staff audit has proven
to be the best means of solving the record
problem as the amount of information re-
vealed by the audit has made each staff mem-
ber realize the practical value of good rec-
ords. Once a week the completed records are
reviewed by the auditor, the chairman of the
staff, and the record committee. Each staff
member in rotation acts as auditor for one
month. When any errors or omissions are
discovered a confidential note is given to the
responsible physician, suggesting corrections.
The record is classed as unfinished until cor-
rected. Experience shows no one wants his
records reported as incomplete. Once a month
a consolidated report is presented at a staff
Nineteen Hundred and Forty-two — November
249
meeting for discussion. During the year and
a half that the audit system has heen used at
the Thayer Hospital, it has “brought to light
a wealth of informative, interesting mate-
rial” and has improved greatly the quality of
the medical records.
In a recent paper, I attempted to make a
historical survey of hospital records and
pointed out with a pride all of us can share
that the first hospital established in New
England, the Massachusetts General Hos-
pital, had good medical records beginning
with the first patient admitted in September,
1821. Furthermore, the records were not
stored away unused. The excellent studies of
James Jackson and Enoch Hale on typhoid
fever were based on the analysis of these
clinical records and the careful tabulation of
the facts recorded in them. To observe thor-
oughly, to record accurately, and to analyze
carefully will always he necessary if hospital
patients are to receive the best of care and if
medicine is to continue to advance.
When the Bingham Associates began its
work eleven years ago, I had the mistaken
idea that if small hospitals were assisted by
grants of money to secure the services of a
record clerk and typist or provided with a
dictaphone, the staff physicians would be
thereby stimulated to do their part in prepar-
ing good records. The plan failed and I be-
lieve it will always fail until the physicians
become record-conscious. The Thayer Hos-
pital found a better way. Who can believe
that the audit system which works so well
there will not he found equally successful in
the other small hospitals not only in Maine
but throughout the country as the need for
better records exists everywhere ?
This in brief is a record of what the Bing-
ham Associates Fund has accomplished, in
carrying out the work Mr. Bingham initiated
and has supported so generously. The physi-
cians of Maine have shown their appreciation
of his efforts by building up a cooperative or-
ganization of twenty-six independent hos-
pitals within the state which makes the facili-
ties of all available for each, and which
provides in increasing measure for the self-
education of every doctor connected with
them.
Referexcer
1. Fisher, P. R. : Professional Audit in the Small
Hospital. Trans. New Eng. Hosp. Assembly,
Twentieth Annual Meeting, 116, 1942.
2. Fisher, P. R. : Records: — The Problem of
Every Hospital. Jour, of the Maine Med.
Assoc., 33:113 (June), 1942.
3. Hale, E.: Observations on the Typhoid Fever
of New England. Boston, 1839.
4. Hiebert, J. C.: Presidential Address. Trans.
New Eng. Hosp. Assembly, Twentieth Annual
Meeting, 97, 1942.
5. Hill, F. T.: Small Hospital Symposium Dis-
cussion. Trans. New Eng. Hosp. Assembly,
Twentieth Annual Meeting, 44, 1942.
6. Hill, F. T.: The Place of the Hospital in a
Continuation Program of Graduate Medical
Education. Jour, of the Maine Med. Assoc.,
32:7 (Jan.), 1941.
7. Hill, F. T. : Continuation Education: A Re-
sponsibility of Otolaryngology. Annals of Otol-
ogy, Rhinology, and Laryngology, 50:1038
(Dec.), 1941.
8. Jackson, J.: Report Founded on the Cases of
Typhoid Fever, or the Common Continued
Fever of New England which Occurred in the
Massachusetts General Hospital, from the
Opening of that Institution in September.
1821, to the end of 1835. Boston, 1838.
9. Leonard, J. C. : Laboratory and Diagnostic
Facilities in the Smaller Hospital. Trans.
New Eng. Hosp. Assembly, Twentieth Annual
Meeting, 39, 1942.
10. MacEachern, M. T.: Medical Records in the
Hospital. Physician’s Record Company, Chi-
cago, 1937.
11. Pratt, J. H.: Adequate Clinical Records — A
Professional Responsibility. Trans. New Eng.
Hosp. Assembly, Twentieth Annual Meeting,
33, 1942.
12. Pratt, J. H.: Better Rural Medicine. Ameri-
can Med. Assoc. Bulletin, 27:122 (June), 1932,
13. Proger, S.: The Tufts Postgraduate Medical
Program. New Eng. Jour, of Medicine, 225:
351, 1941.
14. Proger, S. : The Joseph H. Pratt Diagnostic
Hospital. Neio Eng. Jour, of Medicine, 220:
771, 1939.
In tuberculosis I suggest that we are in
this and in other countries, underarmed for
the defense of the healthy as well as for the
defense of the sick. — J. B. McDougall, M.
D., Bull, de VUnion, Inter. Contre Tuber.,
July, 1939.
The Journal of the Maine Medical Association
A Simple Efficient Splint for First Aid Care of the Injured Arm
or Leg ^
Bv Arthuk H. Parciier, L)., Ellsworth, Maine
If a Thomas, Keller-Blake or similar
splint is not available, a l)oard serves as a
good splint.
The splint described hdow is a hoard splint
but modified so as to permit its application in
various positions to the arm or leg.
The splint suggested is made of % inch
plywood, 31/2 inches wide, with an expanded
head end. The comhined splint, which will
fit either arm or leg, consists of three sec-
tions: sections A, B, and C; 12, 24. and 36
inches in lengdh, respectively. Sections A and
B form an arm splint. Sections B and 0
form a leg splint.
The splint has double slots and holts with
wiiio’ lints as a means for adjusting it quickly
o
and firmly to different lengths and angles.
The broad headed end acts as a means of fix-
ation; as a spreader for a traction sling; to
prevent rotation of the extremity and foi
patient contact.
It may be applied either to the outer or
the inner side of the leg, and reversed foi
injuries about the ankle joint. AVhen fixed
traction is indicated, the outer splint is
preferable and may he extended to reach well
above the hip and below the foot.
Section B alone makes a good inner arm
splint, and sections A and B form an arm
splint that is easily adjusted for length and
also for any desired angle at the elbow.
To stabilize the splint fixation hands from
holes in the head end cross over the shoulder
and are tied under the opposite shoulder.
Nineteen Hundred and Forty-two — November
251
The President's Page
To the Members of the Maine Medical Association :
At a meeting of the Council and Scientific Committee of the Maine Medical Association
held at Waterville, Sunday, October 25th, 1942, it was voted that the 1943 meeting of the Asso-
ciation be a business meeting of one day to be held on Sunday, June 20th, at the Augusta House,
Augusta, Maine. This meeting will consist of a Council meeting and the First Meeting of the
House of Delegates in the morning, and the Second Meeting of the House of Delegates in the
afternoon, with dinner at noon featuring one speaker.
This decision followed considerable discussion by Council and Scientific Committee mem-
bers, as well as by the Councilors in session at Belfast on July 26, 1942, at which time it was voted
to postpone decision regarding the 1943 session until the October meeting of the Council.
The Councilors emphasized the importance of County Delegates, stressing the fact that
these delegates MUST be chosen with care in-as-much as they are representing the County Socie-
ties in the House of Delegates ; the legislative body of your Association.
The election of Officers was discussed at length and the Council expressed an opinion that
the present officers should continue in office for the duration.
This will be only one of many important questions which will confront the 1943 meeting of
the House of Delegates. I do, therefore, urge the County Societies to elect delegates who will
attend this meeting and take an active part therein.
All members of the Association, who are not delegates, are also urged to attend this meeting.
Lieut. Col. Stephen A. Cobb, M. C., President-elect of the Maine Aledical Association, and
Major Norman IT. Nickerson, M. C., Councilor, Sixth District, were unable to be present at this
meeting because both are in active service with the Lbiited States Army.
A letter which I have recently received from Lieut. Col. Cobb, follows in part :
‘Dear Carl :
Oct. 11, 1942
67th General Hospital
As you know the 67th General Hospital sponsored by the Maine General Hospital, and
composed of Maine doctors is attached to the Station Hospital here at Fort Bliss for instruc-
tion and intensive training. At the present time we have working at the Station Hospital,
members of our unit, and sixty-six nurses from New England, most of them from Maine.
We are all well and happy. Many of the Officers have their wives with them so that we
have many pleasant get-togethers. Lieut. Col. Moore (Roland D.) makes a great Commanding
Officer and has the respect and admiration of all the men. Our enlisted personnel is made up
of men mostly from the southwest. There are about five hundred of them. They are a fine lot
of boys and soldiers. They had three months’ training before we arrived.
El Paso really is a beautiful spot. Eort Bliss is situated on the United States side of the
Rio Grande River, and at the base of the Rocky Mountains, with some of the camps on the
slopes. The sun has shone every day that we have been here. When it rains it is generally in
the night. This is probably due to the fact that we are at 4,000 feet elevation. The days are
warm and the nights cool. We are still in khaki, and our shirt sleeves. The people of El Paso
have really been more than hospitable. The Chamber of Commerce, Service Clubs, and Religious
Organizations are continually having entertainments for everyone in the service. W e are across
the river from Juarez in old Mexico, a favorite retreat for the service men.
This is our daily schedule :
6.00 A.M. Reveille
6.45- 7.00 Calisthenics
7.00- 7.30 Breakfast
7.30- 8.30 Close Order Drill
8.30- 12.00 Work in operating room and on
the wards
12.00- 13.00 Lunch
13.00- 16.30 Work on the wards
17.00- 18.00 Dinner
18.00- 19.00 Lectures (Note the army time)
19.00- 22.00 Free to write letters, play cards,
or go to the movies
22.00 Taps
From Saturday noon until Monday at 6.00 A. M., those who are not on duty are free.
There have been trips to the Carlsbad Caverns, and up and down the Rio Grande Valley. These
in addition to being enjoyable are very instructive and educational.
I do want to say that we have as finely trained doctors in our unit (and all from the State
of Maine) as there are in the Army. I am sure that wherever we go our bunch will not shirk
and that some day when this holocaust is over the 67th General Hospital will have been a credit
to the Army of the United States and the State of Maine.
Sorry I will not be able to be with you at the Council Meeting of the Association. Give my
greetings to all the members.
Kindest regards,
(signed) Steve.”
Major Nickerson, in a letter to your Secretary, Doctor Carter, also expressed regret at not
being able to attend the Council Meeting.
Carl H. Stevens, M. D,,
President, Maine Medical Association.
252
The Journal of the Maine Medical Association
Editorials
Maine Medical Association
Annual Session — 1943
The House of Delegates of the Maine
Medical Association in session on Time 22,
1942, at Poland Sju’ing, voted that the de-
cision relative to whether or not we have a
1943 annual session be left in the hands of
the Conncih* As yon will note in the Presi-
dent’s Page, published in this issue, the Coun-
cil on Sunday, October 25th, voted that a one-
day business meeting be held in 1943 instead
of the regular meeting of the Association.
This is the first time an annual meeting
has been cancelled in the history of the Maine
Medical Association, which met and organ-
ized at the Tontine Hotel, Brunswick, April
25, 1853, and held the First Annual Meeting
in Winthrop Hall, Augaista, on June 1, 1853.
The work of the Association must, how-
ever, be carried on and it is with this in mind
that the Council has voted to hold a one-day
business meeting on Sunday, June 20, 1943,
at the Augusta House, Augusta, Maine, in
order that the House of Delegates composed
of delegates elected by the component county
societies, and the officers of the Association,
may meet and keep the affairs of the Associa-
tion in order.
Members who are not delegates are also
invited to attend this meeting, yonr opinions
will be welcome, and given consideration by
the members of the House of Delegates.
*Proceedings — 90th Annual Session — Page 262.
1943 A,M,A, Meeting Cancelled
Announcement was made on September
17th that the American Medical Association
has decided to cancel its ninety-fourth annual
meeting next year in order to keep at their
practice the small force of physicians that
will be left by that time to care for the
civilian population.
The cancellation of the meeting, which was
scheduled to be held in San Francisco, marks
the first time since the Civil War that the
A. M. A. has postponed an annual session.
In place of the annnal meeting, the
A. M. A. House of Delegates, Board of Trus-
tees, Scientific Councils, and officers will
meet in Chicago next June to deal with the
necessary business of the Association and
war-time problems of the medical profession.
Attention!
We call yonr attention to the articles which
follow : the first from the Directing Board of
the Procurement and Assignment Service,
and the second relative to Emergency Base
Hospitals. We feel that information of this
nature, which comes to us from time to time,
is of interest and importance to each of our
members and will, therefore, make it a policy
to devote a portion of the editorial section of
the JouEXAL to the publication of same.
Office of War Information
War Manpower Commission
‘^‘'The Directing Board of the Procurement
and Assignment Service is pleased to an-
nounce that 95 percent of the 1942 procure-
ment objective of medical officers for the
armed forces has already been met. Toward
this total a number of States have supplied
more than their share of physicians and only
a few States are lagging behind in their
quotas. It is from these States that the addi-
tional physicians needed during the current
year should come.
‘'The recruitment of such a large number
of physicians in a few months is a remark-
able achievement and another demonstration
of the traditional patriotism and unselfish-
ness of the medical profession. In this
achievement, and particularly in those of its
members who are “in service,” the profession
can justifiably take pride.
“The end, of course, is not yet. Increases
in the armed forces will necessitate more
medical officers and additional demands will
be made upon' the profession for medical ser-
vices in critical war production areas. The
Directing Board is convinced, however, that
Nineteen Hundred and Forty- two — November
the physicians of this country will respond to
future calls for service, whatever they may
be, in the same splendid manner with which
they have already volunteered for service
with the armed forces.”
Signed :
Feank H. Lahey, M. I).,
Haeold S. Diehe, M. D.,
Haevey B. Stone, M. D.,
James E. Paullin, M. D.,
C. WlELAED CaMALIEE, D. D. S.,
Of the Directing Board.
Civilian Defense— Emergency
Base Hospitals
The Medical Division of the U. S. Office
of Civilian Defense, through its Regional
Medical Officers and State Chiefs of Emer-
gency Medical Service, has now made emer-
gency provision for the establishment of a
chain of Emergency Base Hospitals in the
interior of all the coastal States. They will
be activated only in the event of an enemy
attack upon our coast which necessitates the
evacuation of coastal hospitals. Each base
hospital will be related to the casualty receiv-
ing hospital which has been evacuated and it
is expected that the staff will be recruited
largely from the parent institution.
In order to meet a sudden and unexpected
crisis without delay, arrangements have been
completed with State authorities for the
prompt taking over of appropriate institu-
253
tions in the interior of the State for this pur-
pose and with local military establishments
for the transportation of casualties and other
hospitalized persons along appropriate lines
of evacuation.
More than 150 hospitals in the coastal cit-
ies are in the process of organizing small
affiliated units of physicians and surgeons,
which will be prepared to staff the Emer-
gency Base Hospitals if they should be
needed. These units are composed of the
older members of the staff and those with
physical disabilities which render them ineli-
gible for military service, and of women
physicians. In order that a balanced profes-
sional team may be immediately available the
doctors comprising units are being commis-
sioned in the inactive Reserve of the H. S.
Public Health Service so that, if called to
duty, they may receive the rank, pay and
allowances ecpiivalent to that of an officer in
the armed forces.
Dr. George Baehr, Chief Medical Officer
of the U. S. Office of Civilian Defense, states
that the members of these affiliated hospital
units will continue to remain on an inactive
status for the duration of the war, unless a
serious enemy attack occurs in their Region
which necessitates the transfer of casualties
to protected sites in the interior. Their com-
missions may be terminated upon their re-
quest six months after the end of the war, or
sooner if approved by the Surgeon General.
Such approval will be given in the event such
officer desires active duty in the Army or
ISTavy.
Maternal and Child Welfare
Prenatal Care
(Continued fro?n the October, 19J/.2, Issue of the Jouenal, Page 23d)
The necessity for increased care in the last
three months of pregnancy makes it impera-
tive that the physician demand that the pa- ,
tient keep in close touch with him. He should
tell her the main symptoms to watch for and
report so that she will not think they are part
of the normal discomforts.
If the patient is at a distance and cannot
call, the physician should be doubly careful
in his instructions and should insist that
specimens of urine be sent at intervals of
three weeks at the most. It is here that the
visiting nurse will prove very valuable. She
254
The Journal of the Maine Medical Association
can take the blood pressure and inquire for
symptoms of trouble.
Every effort slionld be made in the last
weeks of pregnancy to induce the j^rospective
mother to nnrse her l>aby. Physicians have
no need to be told the advantages of breast
feeding but far too many women believe that
bottle feeding is jnst as good and mnch easier.
It requires active interest on the part of the
doctor to combat this belief and the tendency
of mothers to give np too easily. A large
factor in the premature abandonment of
breast feeding is the determination of nurses
and superintendents of small hospitals that
the newborn shall gain rapidly. If they could
be induced to take pride in turning out breast
fed babies instead of babies heavier by a few
ounces than when they were born, much good
would result. This change can be brought
about by the concerted action of the physi-
cians of the locality. AVe have altogether too
few breast fed infants.
In the last months the tub bath is omitted,
but sponge and shower baths should be en-
couraged. Intercourse is not permitted. At
this time the hospital arrangements are veri-
fied, and the patient told what to do and
whom to call when labor starts. She should
also be told the symptoms of labor and what
to expect. Many intelligent women have no
knowledo'e of these matters and the advice of
tv'
friends is usually bad. IMucli panic and
trouble will be averted if the gravida under-
stands that the first pain is not an instant
emergency.
The question of analgesia and anaesthesia
should be discussed with the patient. This is
not an article on obstetric analgesia but we
do feel that the physician should not allow
himself to be induced by competition to over-
do the drugging of patients. There is as yet
no safe method of procuring a painless labor.
If it is explained to the mother that the baby
gets the drug also, she is likely to be less de-
manding. It is proper, however, to assure her
that she will not be made to “tough it out.”
After six months or more of association
such as that outlined above mother and doctor
can face the climax of labor with confidence
based on mutual understanding. This state
of mind is well worth the moderate amount
of extra time and effort required to establish
it.
Experience in one county of this state has
shown that the relationship between doctor
and maternity patient outlined above can be
attained. This county has the best maternal
and neonatal record in the state in spite of
the fact that it is largel}^ rural. The physi-
cians here determined that care of mothers
and newborns should improve. They did mis-
sionary work, talking about the advantages of
prenatal care. They caused word to get
around that they would not attend in labor a
patient not before seen. Actually, of course,
no woman was refused but the community
was made to think.
This missionary work was taken up by
neighborhood groups of women. They began
to insist on prenatal care for themselves and
their friends. If one of their neighbors was
not bothering to have proper care, they would
scold her and tell her that if she did not go
to the doctor now, he would not come to her
when she wanted him.
Then, having persuaded the community to
seek prenatal care, these men saw that it was
properly given. The work paid big dividends
in health, to say nothing of the doctors’ en-
hanced reputations. This result can be ob-
tained anywhere that physicians will show
interest.
Prenatal clinics are deserving of more sup-
port than the physicians of Maine give.
There are now only three in the state, in
Portland, Lewiston, and Bangor. Your com-
mittee feels that more should be established,
especially in communities to which there has
been an influx of people. Small hospitals or
community centers can be utilized. The pub-
lic health nurses are anxious to help, and
there is always someone who has had hospital
experience to act as clerk.
It should be recognized that a well run
clinic is not in competition with local physi-
cians because it accepts only those who are
unable to pay a fee. As the time of delivery
approaches, the record is sent to the patient’s
physician. He would, of course, be notified
at once if abnormalities were discovered.
Thus the doctor is forewarned and can pre-
Continued on page 257
Nineteen Hundred and Forty-two — November
255
COUNTY SOCIETIES
Androscoggin
President, Camp C. Thomas, M. D., Lewiston
Secretary, Charles W. Steele, M. D., Lewiston
Aroostook
President, Thomas G. Harvey, M. D., Mars Hill
Secretary, Clyde I. Swett, M. D., Island Falls
Cumberland
President, Roland B. Moore, M. D., Portland
Secretary, Eugene E. O’Donnell, M. D., Portland
Franklin
President, James W. Reed, M. D., Farmington
Secretary, George L. Pratt, M. D., Farmington
Hancock
President, Ralph W. Wakefield, M. D., Bar Harbor
Secretary, M. A. Torrey, M. D., Ellsworth
Kennebec
President, L. Armand Guite, M. D., Waterville
Secretary, Frederick R. Carter, M. D., Augusta
Knox
President, James Carswell, M. D., Camden
Secretary, A. J. Fuller, M. D., Pemaquid
Linco In-Sagadahoc
President, Edwin M. Fuller, Jr., M. D., Bath
Secretary, Jacob Smith, M. D., Bath
Oxford
President, Lester Adams, M. U., Greenwood Mt.
Secretary, J. S. Sturtevant, M. D., Dixfield
Penobscot
President, Albert W. Fellows, M. D., Bangor
Secretary, Forrest B. Ames, M. D., Bangor
Piscataquis
President, Albert M. Cardy, M. D., Milo
Secretary, Harvey C. Bundy, M. D., Milo
Somerset
President, Allan J. Stinchfield, M. D., Skowhegan
Secretary, M. E. Lord, M. D., Skowhegan
Waldo
President, Lester R. Nesbitt, M. D., Bucksport
Secretary, R. L. Torrey, M. D., Searsport
Washington
President, Perley J. Mundie, M. D., Calais
Secretary, James C. Bates, M. D., Eastport
York
President, Carl E. Richards, M. D., Alfred
Secretary, C. W. Kinghorn, M. D., Kittery
County News and Notes
Knox
The regular meeting of the Knox County Medi-
cal Society was held at the Copper Kettle, Rock-
land, Maine, on September 8, 1942, with Samuel
Lowis, M. D., of Boston as guest speaker.
Doctor Lowis is a neuro-surgeon, and spoke on
the acute low back conditions, stressing the fact
that all of the acute low back conditions look alike
at first, and that until the muscular spasm is re-
duced no definite diagnosis can be made. The best
way to accomplish this is to have the patient lie
flat on his back with boards under the mattress
and apply heat to the painful area. Operations
and treatments were outlined. Special braces were
mentioned, special operations were described, and
the prognosis of untreated and treated cases com-
pared.
It was a very interesting talk, and much enjoyed
hv those present.
A. .1. FrixEU, M. D.,
Secretary.
Oxford
The annual meeting of the Oxford County Medi-
cal Society was held at Rumford, Maine, on Fri-
day, October 9, 1942.
The afternoon session was held at the Rumford
Community Hospital at .3.30 P. M., at which time
a Surgical Clinic was conducted by Howard M.
Clute, M. D., Chief Surgeon, Massachusetts Me-
morial Hospital, Boston. A number of gall bladder
cases were presented and discussed.
At 5.00 P. M., a business meeting was, called to
order by the President, Albert P. Royal, M. D., of
Rumford. Reports of the previous meeting, and of
the Secretary and Treasurer were presented and
accepted. An application for membership was re-
ceived and referred to the Councilors.
The following Officers were elected for the en-
suing year:
President, Lester Adams, M. D., Greenwood
Mountain.
Vice President, Fred L. Smalley, M. D., Bryant
Pond.
Secretary-Treasurer, .1. S. Sturtevant, M. D.,
Dixfield.
Councilors: Drs. R. R. Tibbetts, J. A. Green and
.1. A. MacDougall.
Delegate to the Maine Medical Association An-
nual Session, Harold W. Stanwood, M. D., Rum-
ford.
Alternate, Garfield G. Defoe, M. D., Dixfield.
The evening session was held at the Hotel
Harris. After dinner Doctor Clute gave an excel-
lent lecture on The Problems of Acute Cholecysti-
tis with X-ray pictures.
Twenty members and two guests were at the
business meeting, and thirty-two physicians and
iadies attended the dinner.
J. S. Sturtevant, M. D.,
Secretary.
Penobscot
The regular meeting of the Penobscot County
Medical Association was held at the Bangor House,
Tuesday, October 20th, 1942.
Following a brief business meeting, two Medical
Officers from the Dow Field were the speakers.
256
Lieutenant Mason Trowbridge spoke on the sub-
ject Venereal Disease Control in the Army, and
Lieutenant John Kennard reported on Reports of
Surgery at Pearl Harbor, as presented by Colonel
Moorhead at a meeting in Boston, October 19th.
There were forty in attendance.
Forkest B. Ames, M. D.,
Secretary.
York
The fall meeting of the York County Medical
Association was held at the Henrietta Goodall
Hospital, Sanford, Maine, October 14, 1942. An ex-
cellent turkey dinner was served at 1.00 P. M.,
and the business meeting followed at 2.00 P. M.
A committee composed of Drs. Edward M. Cook,
James H. MacDonald, and Owen B. Head, was
appointed to make a study of the advisability of
continuing meetings for the duration.
It was voted to have the annual meeting at the
York Hospital, York Village, Maine, with Drs.
Cook, and Pliny A. Allen, in charge.
Following the meeting Lt. Comdr. S. N. Garde-
ner (M. C.), U. S. N., of the Navy Yard in Kittery,
gave an interesting talk on Diabetes.
Other guests from the Navy Yard were Drs.
Angel and Gray.
There were sixteen members and three guests
present.
C. W. Kinghorn, M. D.,
Secretary.
Members in Military Service
In keeping with our policy to have a complete
record of Maine doctors in the various branches of
the Service, we herewith give second supplement
to the list in the September, 1942, issue. Names
are given by Counties, alphabetically with home
addresses as it is impossible to keep up with the
changes in the rank and service. We will appre-
ciate having any reader advise us of names that
have been omitted.
Androscoggin
Bousquet, Jean,
Lewiston
Cumberland
Branson, Sidney R.,
South Windham
Lovelace, Daniel,
Gorham
Franklin
Springer, Frank L.,
Farmington
Hancock
Cofiin, Ernest L., Northeast Harbor
Coffin, Raymond B., Southwest Harbor
Coffin, Silas A.,
Bar Harbor
Kennebec
Bourassa, Harvey J.,
Waterville
Cyr, Gerald A.,
Waterville
Fay, Thomas F.,
Augusta
Murphy, Norman B.,
Augusta
Knox
Earle, Ralph P.,
Vinalhaven
Jones, Paul A.,
Union
Lincoln-Sagadah
oc
Winchenbach, Francis A.,
Bath
Oxford
Eastman, Charles W.,
Livermore Falis
Howard, Henry M.,
Rumford
Somerset
Bernard, Albert J.,
Skowhegan
The Journal of the Maine Medical Association
Necrologies
Adelbert Beeman Allen, M. D.,
1879-1942
Adelbert Beeman Allen, M. D., 63, died suddenly
at his home in Richmond, Maine, on October 8,
1942. He had been in poor health for several years
and had recently been a patient in a Lewiston
hospital.
Doctor Allen was graduated from the University
of Vermont Medical School in 1904. He was
physician at Sing Sing prison for fifteen years,
and practiced several years in New York City, and
in Waterville, Corinna, and Richmond, Maine.
He was a member of the American Medical Asso-
ciation, Maine Medical Association, Kennebec
County Medical Society, and of the Episcopal
Church, Richmond Lodge, I. O. 0. F., and the
Masonic bodies in Waterville.
Three generations in his family have been doc-
tors, as his father was a physician and his son,
Joel Allen, is now a physician with the United
States Army.
Doctor Allen is survived by his wife, Delevan
Ann Allen; his son, and a daughter, Mrs. Winne-
fred Dodge of Burlington, Vermont.
Herbert Huestis Best, M. D.,
1871-1942
Herbert Huestis Best, M. D., 71, who died August
20, 1942, at the summer home of his daughter, Mrs.
Ralph Salter, near Coboconk, Ontario, was one of
the finest representatives of the country doctor
with a widespread general practice.
Doctor Best was born in 1871, in King’s County,
Annapolis Valley, Nova Scotia. He was a direct
descendent of Major William Best, one of the
founders of Halifax. He attended the Berwick
School, Sackville Academy, Dalhousie University,
Halifax, aird received his medical degree from the
University of New York Medical School in 1896.
He practiced in West Pembroke, with short
periods in Eastport and Easton, for forty-six years.
An exceptionally able diagnostician who gave him-
self without reserve to the care of his patients, he
established a wonderful record, particularly in the
care of obstetricai cases and in the treatment of
fractures.
Doctor Best was a member of the American
Medical Association, Maine Medical Association,
Washington County Medical Society, and of the
Crescent Lodge of Masons.
While in New York, he married Lulu Fisher,
also of King’s County, Nova Scotia, who died
August 19, 1940.
Doctor Best is survived by his daughter, Mrs.
W. R. Salter, wife of W. R. Salter, K. C., of To-
ronto, and by his son. Surgeon Lieutenant-Com-
mander C. H. Best, director of Banting and Best
Department of Medical Research, University of
Toronto, and co-discoverer of insulin with the late
Major Sir Frederick Banting.
Nineteen Hundred and Forty-two — November
257
Book Reviews
“Abdominal and Genito-Urinary Injuries”
Prepared under, the Auspices of the Committee
on Surgery of the Division of Medical Sci-
ences of the National Research Council.
Published by W. B. Saunders Company, Philadel-
phia and London, 1942. Price, $3.00.
As stated in the Introduction, “This volume is
one of a series developed under the auspices of the
Division of Medical Sciences of the National Re-
search Council to furnish the medical departments
of the United States Army and Navy with compact
presentations of necessary information in the field
of military surgery” and covers quite thoroughly
the subjects of abdominal injuries and genito-
urinary injuries. There are eleven chapters de-
voted to the injuries of the abdomen and six chap-
ters on injuries of the genito-ur inary tract, the last
chapter entitled “Do’s and Don’ts” which contains
much valimble information in a concise text.
While this book Js of special interest to the man
doing military surgery, it is a volume which every
physician should possess.
“Immunology”
By: Noble Pierce Sherwood, Ph. D., M. D., F. A.
C. P.; Professor of Bacteriology, University
of Kansas and Pathologist to the Lawrence
Memorial Hospital, Lawrence, Kansas.
Second Edition.
Illustrated.
Published by The C. V. Mosby Company, St.
Louis, 1941. Price, $6.50.
The author has tried to include in this, his sec-
ond edition, the most important features of the
knowledge acquired during the last six years, the
time elapsed since the publication of the first edi-
tion. Some of the material was rearranged for
the convenience of the student. The chapter on
the chemistry of colloids appears as an appendix
in order to facilitate the students’ needs. The
chapter on serology of syphilis has been revised
so as to conform to the requirements of the “Com-
mittee on the Need of Adherence to Conventional
Technique in the Performance of Reliable Serolo-
gic Tests for Syphilis.”
For Sale or Lease
Well located Doctor’s residence, thoroughly mod-
ern, with office suite attached, in West Pembroke,
Maine, where extensive medical practice carried
on for past forty years. No other Doctor in town.
Address inquiries to:
Dr. C. H. Best,
Banting & Best Department of
Medical Research,
University of Toronto,
Toronto, Canada.
Matey'nal and Child Welfare — Continued from page 25 Jt
pare himself or send the woman to a properly
equipped hospital. Many an emergency
would not have arisen if the physician had
been able to obtain previous knowledge of the
condition. It is quite possible that in some
instances doctors will wish to send to a well-
conducted clinic patients who are not strictly
free cases. The clinic would accept these
women on written request from the referring
physician, who would thus be relieved of a
burden and, at the same time, assured that
his patient was being adequately cared for.
Unfortunately, the mere mention of the
word “clinic” conjures up in some the vision
of state medicine. The best way to avoid
state medicine is to do the work ourselves.
That is what the government wishes and gov-
ernment agencies will help us to do it. If we
fail, what a wonderful talking point is given
to the demagogue. “Mothers and children
are not getting good care. Elect me and I’ll
see that they do.” Then we shall see not
state medicine but political medicine and it
will be our own fault.
Your committee again urges individuals
and county societies to devote thought and
effort to maternal and child welfare. Our
record is none too good. We are well down
in the list. Let’s do something about it.
Your Committee on Maternal
AND Child Welfare.
258
The Journal of the Maine Medical Association
NINETIETH ANNUAL SESSION
Maine Medical AiAocdalion
POLAND SPRING, MAINE
JUNE 21, 22, 23, 1942
CONTINUED FROM THE OCTOBER ISSUE OF THE JOURNAL, PAGE 242
SECOND MEETING OF THE HOUSE OF
DELEGATES, JUNE 22, 1942
The second meeting of the House of Delegates of
the Maine Medical Association convened at 5.40
o’clock in the afternoon, on June 22, 1942, at the
Poland Spring House, Poland Spring, Maine, with
Dr. Carl H. Stevens of Belfast, President-elect of
the Maine Medical Association, presiding.
Chairman Stevens: The meeting will please
come to order. Our Secretary, Dr. Frederick R.
Carter of Augusta, will give the roll call first.
(Secretary Carter then called the roll and the
following delegates responded;)
Androscoggin: — Ralph A. Goodwin, M. D.,
Auburn; Merrill S. F. Greene, M. D., Lewiston. Al-
ternates: Otis B. Tibbetts, M. D., Auburn; Albert
W. Plummer, M. D., Lisbon Falls.
Aroostook: — Thomas G. Harvey, M. D., Mars
Hill.
Cumberland: — Thomas A. Foster, M. D., Port-
land; Frank A. Smith, M. D., Westbrook; DeForest
Weeks, M. D., Portland; Elton R. Blaisdell, M. D.,
Portland; Philip H. McCrum, M. D., Portland;
Clyde E. Richardson, M. D., Brunswick; Richard
S. Hawkes, M. D., Portland.
Franklin: — George L. Pratt, M. D., Farmington.
Kennebec: — Blynn 0. Goodrich, M. D., Water-
ville.
Knox: — C. Harold Jameson, M. D., Rockland.
Alternate: Abbott J. Fuller, M. D., Pemaquid.
Lincoln-Sagadahoc: — Virginia C. Hamilton,
M. D., Bath.
Oxford: — Roswell E. Hubbard, M. D., Waterford.
Penobscot: — Ernest T. Young, M. D., Millinocket.
Piscataquis: — Harvey C. Bundy, M. D., Milo.
Somerset: — Allan J. Stinchfield, M. D., Skow-
hegan.
Waldo: — Raymond L. Torrey, M. D., Searsport.
York: — Edward M. Cook, M. D., York Harbor;
Waldron L. Morse, M. D., Springvale. Alternates:
Carl E. Richards, M. D., Alfred; Charles W. King-
horn, M. D., Kittery.
Chairman Stevens: The first order of business
is the report of the Nominating Committee, by Dr.
C. Harold Jameson of Rockland.
Dr. C. Harold Jameson: Mr. Chairman, last
evening, the Nominating Committee met. The
members of the Committee are: Frank A. Smith
of Westbrook, Merrill S. F. Greene of Lewiston, C.
Harold Jameson of Rockland, Raymond L. Torrey
of Searsport, Raymond E. Weymouth of Bar Har-
bor and Harvey C. Bundy of Milo.
(Dr. Jameson read the report of the Nominating
Committee as published in the July, 1942 issue of
the Journal, Page 168.)
Chairman Stevens: You have heard the report
of the Nominating Committee. What action do you
wish to take?
Dr. Carl E. Richards of Alfred: I move the ac-
ceptance of the report of the Nominating Commit-
tee, and I also move that the Secretary cast one
ballot for the election of the persons named in the
report.
This motion was duly seconded by several of the
members present and was carried.
Chairman Stevens: Is the report of the Refer-
ence Committee ready. Dr. Poster?
Dr. Thomas A. Poster of Portland: Your Com-
mittee received two resolutions to consider, the
first of which was discussed and adopted without
much debate. I shall read this for your approval.
The Committee moved that the Council be in-
structed to appoint a Committee from the Maine
Medical Association to follow out the suggestions
made in the letter from Frank Mott, Administra-
tor of the Estate of the late Amy Pinkham, to
Frederick R. Carter, regarding the expenditure of
$20,000 left under the will of the late Amy W.
Pinkham for the use of tuberculous or undernou-
rished children in Maine.
This motion was approved and signed by Dr.
George L. Pratt, Dr. Ernest T. Young and myself.
Therefore, Mr. Chairman, we move that this sug-
gestion be adopted.
This motion was duly seconded by several of the
members present, and was carried by a hand vote.
Dr. Thomas A. Poster; Mr. Chairman, the other
motion seems to be controversial, and at the meet-
ing, arguments were heard for and against the mo-
tion. First, I will read the motion, which was from
the Council.
“It was moved by the Council that the Associa-
tion express its opinion to the Governor and the
Legislative bodies that the supervision of the dis-
tribution of milk in Maine should be under the
Department of Health rather than under the De-
partment of Agriculture.”
Your Committee had a meeting this afternoon,
attended by the head of our Department of Health
and by Dr. Norman H. Nickerson and Dr. Clinton
N. Peters, and the Committee, and they heard ar-
guments in favor of the motion, and arguments
against the motion.
Your Committee submits the following:
Whereas, the members of the Maine Medical
Association recognize that many cases of tubercu-
losis and undulant fever are reported in Maine
each year, and
Whereas, tuberculosis and undulant fever are
contracted from drinking raw milk from infected
cows, and
Whereas, cattle infected with tuberculosis and
Bangs Disease can and should be detected and
eradicated from the herds in Maine,
Therefore, Be It Resolved, that this Association
respectfully ask the Department of Agriculture, in
Nineteen Hundred and Forty- two — November
which Department the control of milk production
and distribution rests, to pursue a vigorous cam-
paign against these diseases in the herds of Maine,
and
Be It FxmxHER Resolved, that the Association
request the Department of Agriculture in coopera-
tion with the Department of Health to inaugurate
a campaign for education on the necessity of clean
milk and the advantages of Pasteurization of milk.
This resolution is signed by George L. Pratt,
Thomas A. Foster and Ernest T. Young.
The Committee moves the adoption of this sub-
stitute resolution.
This motion was duly seconded by several of the
members present, and was carried, with two dis-
senting votes.
Chaikmax Stetvexs: The next order of business
is the election of Councilors. We have three to
elect. Dr. Pratt, will you kindly give us the report
for your District.
Dr. George L. Pratt of Farmington: Currier C.
Weymouth was elected Councilor from the Second
District.
Chairman Stevens: The next order of business
is the election of a Councilor from the Third Dis-
trict, to fill the term of William A. Ellingwood, de-
ceased. The Council, at a meeting held in Portland
on October 16, 1941, elected C. Harold Jameson,
M. D., of Rockland, to serve as Councilor until this
Annual Meeting in June, 1942, when the Councilor
for that District would be elected for two years to
fill out the unexpired term.
Nominations for Councilor to the Third District
are now in order.
Dr. Virginia C. Hamilton of Bath: I would like
to nominate Dr. C. Harold Jameson of Rockland.
This motion was duly seconded by Dr. Wey-
mouth of Bar Harbor, and was carried.
Dr. Thomas A. Foster: The First District dele-
gation met in the adjoining room and received the
nominations of candidates for the office of Coun-
cilor; nominations were seconded, and a written
Ballot was taken. The majority of the delegation
present voted in favor of E. Eugene Holt of Port-
land, as Councilor for the First District.
Chairman Stevens : The name of Dr. E. Eugene
Holt has been placed in nomination as Councilor
for the First District. What is your pleasure?
A Member: I move that nominations be closed
and that the Secretary cast one ballot for the elec-
tion of Dr. Holt as Councilor from the First Dis-
trict.
This motion was duly seconded and was carried.
A Member: I also move that the Secretary be in-
structed to cast one ballot for the elections of Dr.
Currier C. Weymouth as Councilor from the Sec-
ond District and Dr. C. Harold Jameson as Coun-
cilor from the Third District.
This motion was duly seconded and was carried.
Secretary Carter: I have cast the ballots, elect-
ing these men as Councilors for the First, Second
and Third Districts, respectively; Dr. E. Eugene
Holt, Dr. C. C. Weymouth, and Dr. C. Harold
Jameson.
Chairman Stevens: The next order of business
is that of unfinished business. We are awaiting
the report of Dr. Neil A. Fogg of Rockland, as the
Delegate to the 1942 Connecticut State Medical
Society meeting. Dr. Fogg is not present.
Next, is the report of Standing and Special Com-
mittees not submitted for publication and not pre-
sented to the First Meeting of the House of Dele-
gates on June 21, 1942.
First, is the report of the Committee on Medical
Education and Hospitals by Dr. Adam P. Leighton
of Portland.
Dr. Adam P. Leighton: I have quite a lengthy
report here, and if you desire I shall read only the
highlights.
(It was requested that Dr. Leighton read the
entire report, which follows:)
The general picture and outlook of, and for. Hos-
pital service and medical practice in Maine is per-
plexing and serious indeed. With the Country at
War and demands being made on the Medical Pro-
fession and the Hospitals such as have never been
equalled before, this report is consequently lengthy
and necessarily replete with observation and dis-
cussion of important matters having to do with
these two activities.
Medical practice in the rural communities has
for some few years been decidedly depleted. The
recent graduates have on the whole, refused to
take up so-called “country practice.” Many towns
and villages which heretofore have had physicians
now have none or are taken care of by the osteo-
paths. The Osteopathic Profession has literally
“taken over” the majority of these places and since
the lamentable error on the part of the Medical
Profession and this Association, in allowing osteo-
paths added privileges of practice which truly ap-
proach the regular practice of medicine, the
younger medical men have sidestepped the com-
petition of the osteopaths and seem, more than
ever, determined to enter practice in the various
cities of the State. There is a slight diminution
too, in the number of medical practitioners in this
State. The Army and Navy will continue to take
many more of the medical men into the service.
Osteopaths are “in clover” in that the citizens will
have to employ them more than ever while the
M. D. does his duty. It is a sad situation and
much of the disturbing element may be laid at our
own door for not having safeguarded our rights
and privileges of practice in the Legislature a
little over a decade ago.
Medical Practitioners are over-worked at present
and will have to take on more of the burden as
time goes on. Hospitals are full to the doors and
in some cases undermanned by staff doctors and
sorely in need of nurses, young women naturally
being lured to occupations paying high wages
rather than being stimulated to entering training
schools.
Hospitals today are confronted with many spe-
cial problems arising from the War and the De-
fense Program. They have all been taking an ac-
tive and vigorous part in working out plans and
programs in co-ordination with Civilian Defense.
The medical care of civilian casualties has become
the duty of the Medical Division of Civilian De-
fense. Organizing the medical resources of the
community has given rise to the development of
what is known as the Emergency Medical Service.
In this program the hospitals are the very corner-
stones on which the emergency medical service
rests in striving to prepare for every conceivable
emergency: such as black-out and fire protection.
Publications of the Medical Division of the Office
of Civilian Defense have outlined approved
methods for organizing the hospital staff in the
field unit. They have also indicated the equipment
and supplies wh.ch will be found suitable for
First Aid posts and casualty stations. It should be
emphasized here that the casualty stations are to
serve as hospital sub-stations located in municipal
buildings in areas which may be remote from the
general hospital and not otherwise adequately
served. They may act as filtering stations to pre-
vent overloading the hospitals with non-serious
cases.
The cost of hospitalizing persons injured as a
result of enemy action will be borne by the Fed-
eral Government. A sum of money has been set
aside for this purpose. It is also proposed to re-
imburse for supplies used in caring for the casual-
ties. A rate to pay for hospitalized patients has
260
The Journal of the Maine Medical Association
been established. The Regional Medical Offices for
Civilian Defense are at present setting iip the ad-
ministrative machinery.
In certain vulnerable areas it may be necessary
to evacuate the hospital at any time. This may be
a partial or total evacuation. It may be necessary
to remove chronic cases from the receiving hos-
pitals to make room for the reception of casualties.
On the other hand, the more protected hospitals
may be called upon to receive patients from evacu-
ated hospitals. This means there must necessarily
be a closer relationship between the hospitals, in
some cases that amounts to an affiliation. Hos-
pital administrators have been busy throughout
the year planning for any eventualities.
The program for the development of extensive
blood banks in the hospital is more than a plan
to meet emergencies.. Blood transfusion is not a
new procedure, although many of the refinements
of technique are recent developments. In the past,
however, the blood transfusion was a tedious and
expensive procedure and was consequently too
often used only in extreme emergencies. With the
proper collection, preparation, and storage of blood
or plasma it becomes a relatively simple and in-
expensive treatment and need not be reserved for
patients in extreme need. The remarkable grati-
fying results obtained at Pearl Harbor were due
in large measure to the prompt and repeated blood
plasma treatment administered to the casualties.
This indicates that blood transfusions either of
whole blood or plasma will become a more stand-
ard procedure in all hospitals. They must be en-
couraged to be prepared for it. The Federal Gov-
ernment recognizing this need has set aside a fund
which is available to the Medical Division of the
Office of Civilian Defense for the establishment of
Blood Banks in these hospitals. The State through
the Office of Civilian Defense has also set aside a
fund for Blood Banks. This will enable them to
provide three Blood Bank Centers here in the State
of Maine; Bangor, Lewiston, and Portland.
Another problem confronting the hospitals has
been the loss of Staff members to the Armed
Forces. It is quite certain that there will be
further losses. In spite of the hardships that this
works on hospitals there is not one that is not
proud that its Staff members are serving their
country. More sacrifices will be made, and made
cheerfully, to insure sufficient medical personnel
for our Army and Navy. Necessarily this will im-
pose added responsibilities to those who remain
at home. In addition to the increased load of car-
ing for the sick, there will be the need for pre-
paring for emergency medical services in these
days of total war. The Maine General Hospital
through its Staff has organized General Hospital,
No. b7. Many of the doctors enlisted with this unit
come from many hospitals throughout the State.
Not alone in the Medical Staff personnel are the
hospitals being depleted; nurses, too, are being
called into the service until hospitals are finding
it more and more difficult to replace them. There
has been established in many hospitals under the
direction oi the Red Cross, Classes lor the training
of Nurse Aides. These are women of independent
income volunteering to aid hospitals without pay.
I'rained to work omy under the direction of gradu-
ate nurses. They increase the nurses efficiency
by doing certain routine tasks requiring no pro-
fessional training. The hospitals have not yet ex-
plored the possiuilities of this field. Many other
volunteer workers have also enlisted their services
in the hospital ;*such as hostesses, clinical clerks,
and canteen workers. Many of the departments
of the hospital, however, suffer for a lack of per-
sonnel. This is particularly true in the Mainte-
nance Department, the Housekeeping Department,
and the Dietary Department. We are told that the
need for trained nurses for duty in the Armed
Forces is not being met. Enlistments, however,
have reduced the available number of nurses for
services in civilian hospitals and concurrently the
increased number of patients in these hospitals has
created a nationwide shortage of nurses for insti-
tutional duty. The enrollment of more students
in schools of nursing has been encouraged by the
United States Department of Public Health plus
supplied funds to Hospital Training Schools for
the advancement of Nurse Education.
Other special problems arising from the war is
of course the obtaining of adequate equipment, and
supplies, under the priorities planned. The whole
purpose of the War Production Board is to see that
the American Industries first supply the munitions
of war in quantities sufficient to insure victory for
the allied nations and second maintain production
and distribution of commodities of civilian supply
necessary for aiding not only the winning of the
war, but also the winning of the peace.
Because of the war demands upon the productive
capacities of the United States, shortages in the
civilian supply of many of our commodities are
altogether inevitable. It is to meet these shortages
or to lessen these effects upon the essential seg-
ments of our economy that the priorities planned
have been affected. Shortages have been brought
about through the decline or cutting off in import
trade or where the severity between supply and
demand is heightened by the necessity for in-
creased export as well as increased domestic con-
sumption. The priority problem becomes a general
problem not only containing the usual elements of
economics and industrial production, but further
complicated by consideration of military strategy,
hemispheric defense, national domestic policy, and
international relations including economic war-
fare. Because of the increasing costs of commodi-
ties and increasing payrolls, it has been necessary
for hospitals to increase hospital rates to the pa-
tients in need to meet increased expenses. Through
the Lanham Act funds have been made available
for hospital construction. Presque Isle General
Hospital, Bath Memorial Hospital, Mercy Hospital,
and the Maine General Hospital, have all had
grants and aid from this source for the purpose of
increasing their hospital facilities to meet the de-
mands brought about by increased industrial ac-
tivities in these communities. Hospital Service
Plans have increased their enrollment with the
result that there has been an increasing number
of hospital admissions by patients holding Blue
Cross Certificates. Forty-five general hospitals and
nearly 50,000 individuals are now members of the
Associated Hospital Service of Maine, which has
been in operation just three and a half years! It
is but one of seventy-one non-profit hospital service
plans operating in the United States and Canada
that meet standards for approval by the American
Hospital Association.
These are indeed trying times for hospitals and
the medical profession. Let us not fail in our re-
sponsibilities. The hospital and the medical affairs
of the Government rests in the hands of respon-
sible people from our own ranks. Let us all bear
in mind the importance and necessity of an effi-
cient health service.
Chairman Stevens: We shall now have the re-
port of the Financial Advisory Committee by Dr.
Albert W. Plummer.
Dr. Albert W. Plummer of Lisbon Falls: Mr.
Chairman and Gentlemen. The Financial Advisory
Committee reported about a year ago; it was
formed to go over the financial standing, the se-
curities and the like, of the Association, and to
make recommendations.
Nineteen Hundred and Forty-two — November
There was not exactly a clear understanding of
just what our function would be, but we finally
concluded that it was merely to make recommenda-
tion for action of the House of Delegates or for
the Council to act upon.
We have looked over, as best we could, and I
think Dr. Kershner has taken up the matter par-
ticularly with some financial brokers as to the
bonds and the securities that are held by the Asso-
ciation, and I think the opinion that he obtained
was that probably no improvement could be made
in that aspect of the investments at the present
time, although perhaps some of them are not too
good.
We have, however, considered the matter of the
funds that are now on deposit in the bank, Mr.
Chairman, and we have brought in the following
report.
The Financial Advisory Committee of your Asso-
ciation recommends that the Council consider the
advisability of investing in war bonds such part
of the funds of the Association now in banks in
savings accounts, as it seems expedient.
This report is dated June 22, 1942, and is signed
by A. W. Plummer, George L. Pratt and Warren
E. Kershner.
Chairman Stevens: The report of the Financial
Advisory Committee, you have heard. Gentlemen.
The Chair awaits any action you wish to take as
to this report.
Secretary Carter: I move that the report of the
Financial Advisory Committee be accepted.
This motion was duly seconded by several of the
members present and was carried.
Chairman Ste\'ens: The next Committee to re-
port is the Committee on Maternal and Child Wel-
fare. Dr. Roland B. Moore of Portland, Chairman
of that Committee, is not here.
The next report we are to hear is that of the
special Committe on Industrial Health, by Dr.
Stephen A. Cobb of Sanford.
Dr. Stephen A. Cobb of Sanford: This is a com-
mittee that is new in this Association. We are one
of the few states that did not have any Committee
on Industrial Health, until Dr. Ebbett appointed a
few of the men to serve on this Committee, owing
to the emergency that has arisen.
As you gentlemen know, the Workmen’s Com-
pensation Act made it necessary that the big in-
dustries in the State, especially in hiring men,
had to have certain rigid physical rules set down
before they were hired.
Now comes the word from the American Medi-
cal Association that we have got to go ahead and
utilize all of our manpower in the State. For that
reason. Dr. Ebbett saw fit to start this Committee
in this State.
The time has come when we, no longer, can
throw out of industry, men with hernias, one eye,
ulcers, high blood pressure, and so forth. We have
got to use the manpower we have and put them
into the right places. For that reason, your Com-
mittee met this noon and got organized to some
extent, and tomorrow noon, we have Dr. Kessler,
Lieutenant-Commander Kessler, who belongs to the
Council on Industrial Health of the American Med-
ical Association, sent to us by the A. M. A., and
we will have a meeting in the first Conference
Room on the right as you come in from the lobby
tomorrow noon at twelve o’clock.
I have contacted twenty or twenty-five men who,
I know, are engaged in industrial surgery and
medicine. I am sure that Dr. Kessler will give us
a fine talk and will tell us just what we have got
to do. Any one who is under industrial health,
hygiene or surgery will be welcome. (Applause)
Chairman Stevens: You have heard Dr. Cobb’s
report. Gentlemen, What is your pleasure?
261
Dr. Clyde E. Richardson of Brunswick: I move
that the report of the Special Committee on In-
dustrial Health be accepted.
This motion was duly seconded and was carried.
Chairman Stevens: Is Dr. Greco of Portland
here, to give his report of the Committee on Tuber-
culosis? He is not here.
Next, we shall have a report from Dr. Frederick
T. Hill regarding his work on the Committee on
Graduate Education.
Dr. Frederick T. Hill of Waterville: Mr. Chair-
man and members, of the House of Delegates. Our
Committee submitfed a report to be published in
the May Journal, which was rather a negative re-
port. It was obvious that the post-graduate activ-
ity which had been carried on for the past two
years would be rather out for the duration of the
war.
The New England Post-Graduate Assembly is to
be given up. The Fellowships that men from many
of the communities in Maine have enjoyed, such as
the Commonwealth Fund, are on the way out. The
Commonwealth Fund will give no Fellowships
after October, and the organized Fellowships will
be out.
Since that time, something else has developed
which I think you should consider. If I can per-
haps just go back a little bit and paint the picture,
I can bring it to you better.
Some few years ago, in the American Academy
of Ophthalmology and Oto-Laryngology, we started
the Home Study Course. This was done to allow
the younger men and perhaps some of the men who
hadn’t had the advantages in the specialties, an
opportunity to improve and to fit themselves to
take one or both of the national examinations.
At that time, I thought it was a rather time-
wasting effort.
At that time, I had to do with the anatomy of
oto-laryngology, and I had to correct examination
papers, with the help of some of my friends. So
I felt it was a complete waste of time.
This year, I was forced to change my mind en-
tirely. We had a number of men coming up for the
Board examinations this spring, men who had
failed before, and who, this year, passed a very
good examination. We, on the Board, were asked
to watch out for these men. I had a number of
them, myself, and I asked them if they had taken
the Home Study Course, and they said they had,
and, without an exception, each one said it was of
immeasurable benefit; it had given them organized
reading.
So, we had evidence and we thought that this
sort of thing was worth while.
In Atlantic City at the time of the American
Medical Association meeting, the Association’s
Committee on Post-Graduate Education, made up
of similar committees from each State, had their
Annual Joint Meeting. There was still this dis-
couraging note, as to what you could do about this.
Each State has a different program, of course. It
was practically out. Yet, everybody was very con-
scious that it was too bad and that something must
be done. In any event, we would do all we could
to keep up the standard of practice.
With the younger men going into the service,
and with the older men not quite so active, being
called into a greater activity in medicine, some
sort of a contribution of education was more neces-
sary than ever.
The only solution I had considered at all was to
further develop the staff programs in the indi-
vidual hospitals.
After that meeting, it occurred to me that per-
haps this Home Study idea might be utilized. I
talked to some of the men, especially Roy Harkins,
who has been Secretary of the Associated Com-
262
The Journal of the Maine Medical Association
mittees since their inception. He felt that it would
be a grand thing to try out. It is the feeling of
the Associated Committees, at least of the Execu-
tive Committee, that perhaps in Maine, we might
try this out as a sort of guinea-pig.
Now, the idea would be something like this. The
graduates in medicine, eye, ear, nose and throat
specialty, would be the ones offered the Home
Study Course, and you men will not have to be
concerned with the machinery of the thing, as that
is all set up; the Academy is going to carry on the
Home Study Course.
We would suggest that a similar course in Sur-
gery, in Medicine, Obstetrics and Pediatrics be in-
augurated.
This would simply suggest organized reading. It
would mean an active sub-committee in each one
of these branches of medicine would have to go to
work. They would suggest certain pertinent sub-
jects, with the references where the xip-to-date
material could be obtained.
As an example, I was talking with Phil Thomp-
son last night, and he was very enthusiastic about
it. He suggested one question that might be of
importance in the medical effort. You know, the
modern treatment of gall bladder disease has
changed, and then where the person taking the
course could find that material so that further
study could be carried on, would be one of the pur-
poses of this sort of post-graduate education. The
same would be true in the different lines of medi-
cine.
Now, the pediatricians are enthusiastic.
I have talked with a number of surgical people,
and they are enthusiastic.
I think the majority of our committee are en-
thusiastic. So that if you care to endorse this, our
Committee will try to organize it, with the help
of some of you people, who will have to take hold
of it.
It will be merely suggested and organized read-
ing along a home study idea. I will leave it for
your consideration.
Chairman Stevens: You have heard Dr. Hill’s
report. What action do you wish to take on this
report at this time. Gentlemen?
Dr. Thomas A. Foster: I move that this sug-
gestion by Dr. Hill be approved, and that the Com-
mittee be urged to map out a program.
This viotion was duly seconded by Dr. Jameson
and others present, and was carried.
Dr. C. Harold Jameson: It occurs to me that
the excellent report of the Committee on Hospitals
and Medical Education was not acted upon.
Chairman Stevens: I believe you are correct.
Dr. Jameson; it was an oversight on my part.
What is your pleasure with reference to this
report?
Dr. C. Harold Jameson: I move the acceptance
of the report of the Committee on Hospitals and
Medical Education.
This motion was duly seconded and was carried.
Chairman Stevens: We now come to the item
of new business. Yesterday, you will recall that
the Council recommended that we do not have a
Fall Clinical Session in 1942. No definite action
has been taken on that point. I think that matter
should be brought up at this time, so I shall place
that subject before the House of Delegates for defi-
nite action as to whether or not we shall have a
Fall Clinical Session; because of the war con-
ditions, many men will be away, and the men at
home are already taxed, so the Council felt that
it was inadvisable to have a session in the fall of
1942.
Dr. Elton R. Blaisdell of Portland: I move that
we approve the council’s recommendation, that we
do not have a Fall Clinical Session in 1942.
This motion was duly seconded by many of the
members present, and was carried.
Chairman Stetv^ens: The next item of new busi-
ness is the matter of the Annual Session in 1943,
whether or not we should have an Annual Session,
and if so, where shall it be? The Chair awaits
your pleasure in this matter.
Dr. George L. Pratt: I move that the Annual
Session matter be left in the hands of the Council.
This matter was duly seconded.
Dr. Albert W. Plummer: I like this place out
here very much, but the question arises as to
whether we can go some place that is more readily
accessible by railroad, provided the present con-
ditions continue.
Upon a hand vote, the motion to leave the An-
nual Session matter in the hands of the Council
was carried.
To be concluded in the December Issue
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The Journal
of the
Medical Association
Uolume Thirti] "three Portland, Ulame, December 1942
No. 12
Newer Knowledge Concerning Arterial Hypertension^
By Laurence B. Ellis, M. D,
From the Thorndike Memorial Laboratory, Second and Fourth Medical Services (Harvard),
Boston City Hospital, and the Department of Medicine, Harvard Medical School
Arterial hypertension (better termed
hyperpiesia, hypertensive cardiovascular dis-
ease, or diffuse arteriolar disease with hyper-
tension) is the most important single patho-
logical syndrome to which mankind is sub-
ject, both from the standpoint of morbidity
and of mortality. Heart disease leads all
other causes of death ; the chief cause of heart
disease is hypertension, and when there is
added to this deaths caused by cerebral acci-
dents and by uremia secondary to hyperten-
sion, the importance of the disturbance be-
comes even more obvious. It is estimated that
10 to 15 per cent of all adults have some de-
gree of hypertension and as many as one-
third of those over 50 may suffer from it.
We are now passing through a period in
medical history when intensive investigation
is going on throughout the world regarding
various aspects of this problem and many
new facts are constantly coming to light.
Most of the experimental work to date has
not yet been translated into widespread, prac-
tical clinical applicability, but there are in-
dications that soon knowledge which has been
and is being gained will be turned to such
practical use. It is my purpose in this com-
munication to present a summary of some of
the recent important work which has been
done in this field.
It is of interest to look back over the years
and consider the changing hypotheses regard-
ing the nature of hypertension. We have in
a sense come almost full circle since the time
of Richard Bright. It was he, who in 1827,
in his epoch-making descriptions of renal
disease, first clearly recognized its associa-
tion with cardiovascular disorders, for he
described “the full, hard pulse” and noted
hypertrophy of the left ventricle in these pa-
tients. This was the genesis of the concept
of high arterial blood pressure as the result
of kidney disease which became firmly im-
planted in medical minds and remained there
throughout the nineteenth century and even
later. There still lingers only too widely that
medical anachronism, the treatment of hyper-
tension by a low-protein, salt-free diet, given
in the belief that “the kidneys will be
spared.”
* Read at the Annual Meeting of the Maine Medical Association, York Harbor, June 23, 1941.
264
111 sjiite of this persistent clinical belief in
the renal origin of hypertension, medical in-
vestigators in the 1870’s began to emphasize
the generalized nature of the vascular disease
in hypertension. Thus Gull and Sutton, in
1872, described the morphological picture of
generalized “arterio-capillary fibrosis” occur-
ring with or without renal disease, and in
1871 that brilliant young British doctor,
Mahomed, was the first properly to recognize
high blood pressure clinically and its impor-
tance as a primary condition. In the 1890’s
and later. Allbutt in England, Huchard in
France, Volhard in Germany and Janeway
in this country were the leaders in bringing
into general acceptance the concept of hyper-
tension as a primary condition. The clinical
recognition of this syndrome was, of course,
vastly stimulated by the introduction of a
practical bedside sphygmomanometer by
Riva-Rocci in 1896, which interestingly
enough was first brought to this country by
Harvey Cushing.
In the early years of this century essential
hypertension came generally to be considered
not only a primary general vascular disturb-
ance but specifically a vasomotor disorder
with a sustained increase in vasomotor tone.
This hypothesis, however, came into serious
question as the result of work of Prinzmetal
and Wilson^ in Boston and Pickering" in
England who showed in human beings that
the increased peripheral vascular resistance
in this condition is independent of vasomotor
tone, while the investigations of Goldblatt
and others in experimental hypertension have
tended to direct attention even further from
the vasomotor etiology. It is with research
stimulated by the pioneer studies of Gold-
blatt® that there has once more been revived
the concept that “essential” hypertension
may be secondary to a renal disorder. Cer-
tainly many instances of hypertension occur-
ring as the result of renal disease are now be-
ing recognized, but as I shall describe to you,
there is not yet any good evidence that the
vast majority of cases of essential hyperten-
sion are caused by primary kidney pathology.
The Pathoge'nesis of Essential Hypertension
It has been demonstrated without shadow
of doubt that in essential arterial hyperten-
The Journal of the Maine Medical Association
sion the pathological factor is increased pe-
ripheral resistance. The chief site for this in-
creased resistance is the arterioles, and the
phenomenon is generalized throughout the
body. In the early stages, in most cases, this
is due to narrowing as the result of spasm of
the vessels and hence is potentially reversible.
Later in the course of the disease organic
changes in the vessels occur and the narrow-
ing becomes at least in part fixed and irrever-
sible. The other two factors which are im-
portant in the maintenance of blood pressure,
the cardiac output and the circulating blood
volume, are normal in this state.
The tone of blood vessels, which is the con-
dition that determines the resistance they
offer to blood flow, is controlled by intrinsic
factors and by vasomotor stimuli. Many fac-
tors alter the intrinsic tone of vessels locally,
regionally and generally. Among them are
circulating hormones such as adrenalin, pi-
tressin, sympathin and hormones of renal
origin.
The autonomic nervous system, through
the vasomotor nerves, has an important influ-
ence on the tone of blood vessels of the skin
.and is responsible for certain general vascu-
lar reflexes such as the postural reflex and
those due to cold and emotion. To what ex-
tent, beyond these reflexes, vasomotor tone is
normally operative in the vessels of the
splanchnic area and the muscles has not been
adequately determined as yet and there is
some evidence that vasomotor influence in
these regions is slight or absent in normal
persons when recumbent and relaxed.
As I have already stated, at present the
bulk of evidence indicates that essential
hypertension is not primarily a vasomotor
phenomenon, but is due to an increase in the
intnnsic tone of the blood vessels. Whether
there is any neural factor, induced by inter-
mittent vasomotor activity, at all has yet to
be proved.
Experimental Hypertension
In 1933, Goldblatt reported the first of a
series of studies in which he showed that per-
manent arterial hypertension can be pro-
duced experimentally in the dog or other ani-
mals by constricting the renal arteries and
thus reducing the blood flow to the kidneys.
265
Nineteen Hundred and Forty-two — December
This work has subsequently been repeated
and confirmed by many other workers and
similar hypertension can also be produced by
a constrictive peri-renal fibrosis produced by
encasing the kidneys in silk or cellophane/
Further research has shown that this hyper-
tension is independent of autonomic nervous
control and hence is not vasomotor in origin,
and that it is not primarily caused by any
abnormal activity of the adrenal or pituitary
glands.
Finally, it has been shown that it is defi-
nitely humoral in origin. The story of the
question for the demonstration of a renal
pressor substance dates back to work done in
1898 by Tigerstedt and Bergman,® work
largely neglected until the recent revival of
interest in this subject. These investigators
described a substance extractable from kid-
ney tissue which raises blood pressure and
named it renin. Recent studies® have con-
firmed and elaborated this finding; studies
carried on in many laboratories but notably
in those of Harrison, of Page, and at the
Institute of Physiology at the University of
Buenos Aires. It is now apparent that the
situation regarding pressor and anti-pressor
activity of renal extracts is a complicated re-
action. In summary it may be as follows:
the kidney releases a substance, renin, into
the blood stream, which is an enzyme. This
itself does not increase blood pressure until
it reacts with a substance in the blood, prob-
ably a globulin, known as renin-activator, or
hypertensin-precursor. The product is pressor
in action and called angiotonfn or hyperten-
sin. There is present in blood and tissues
substances which counter-act the effects both
of renin and of angiotonin and hence are
known as renirv-inliihitor and angiotonin-in-
hibitor, or hypertensinase. It appears prob-
able that these substances, which are also
enzymes, are elaborated by the normal kid-
ney. In experimental hypertension, the high
blood pressure results from an imbalance of
these secretions, either an excess of renin or,
more probably, a deficiency in the production
of the antipressor or inhibiting substances.
Whether the same is true of human hyper-
tension has not yet been clearly demon-
strated.
Very recently it has been shown, both by
Grollman, Williams and Harrison,'^ and by
Page, et al,® that extracts can be obtained
from normal kidneys which, when injected
and even when given by mouth, will lower
the blood pressure of animals with experi-
mental hypertension and, far more impor-
tant, will also reduce the blood pressure for
prolonged periods in patients suffering from
essential hypertension, both benign and ma-
lignant. These results are very suggestive
but it should be emphasized that they are
still in the experimental stage. It has not yet
been detennined whether such reduction of
pressure is entirely desirable, whether harm-
ful side-effects occur, and whether it is last-
ing. Moreover, a very large amount of kid-
ney tissue is required to obtain extract suffi-
cient for the daily dose that patients must be
given.
Schroeder and Adams® have reported the
successful use of tyrosinase in lowering the
blood pressure of animals with experimental
hypertension as well as in certain cases of
human hypertension.
Limits of ISl ormal Blood Pressure, Vascular
Hyperreactability and the Development
of Arterial Hypertension
Questions that have long troubled clini-
cians are: What are the limits of normal
.blood pressure; what is the significance of
(transient rises in the systolic or diastolic
pressures ; when does the disease process com-
mence ; and how early can it be recognized ?
Some light has been thrown on these ques-
tions recently.
It has been long recognized from insurance
statistics that life expectancy decreases with
increasing systolic pressures above 145-150
mm. Hg. Recently, Robinson and BruceP®
have shown from a study of 11,383 individ-
uals that systolic pressures above 120 carried
an increasingly poor prognosis, and they
therefore consider 120 as the upper limit of
normal. This is a rather more radical step in
definition than most authorities are prepared
to take in the light of present evidence.
Of great significance is a study recently
reported by Hines. He made a 10- and 20-
year follow-up investigation of 1,522 persons
admitted to the Mayo Clinic whose admission
pressures ranged from a low to high nonnal
figure (160 mm. Hg. systolic, 100 mm. Hg.
266
diastolic). He found that those patients
whose diastolic pressures were below 85 had
developed hypertension 20 years later in only
3.8 per cent of cases, whereas those whose
diastolic pressures were 85-100 mm. had sub-
sequent hypertension in 50-82 per cent, re-
gardless of whether the systolic pressure was
low or higli (110-160 mm. Hg. ) normal.
Since those patients with high normal pres-
sures at the initial examination fall into that
groujD who are likely to l)e labelled by most
doctors as having an ^^emotional” rise in pres-
sure of no prognostic importance, Hines’ find-
ings are of significance because they indicate,
first, that those individuals who show such
transitory increases of blood pressure into
the higher brackets of normal are very mucb
more likely to develop hypertension subse-
quently, and, second, that the level of the
diastolic pressure is of much gneater impor-
tance than the systolic.
Etiological Factors in Essential Hyper-
tension
In some cases of arterial hypertension the
etiology can definitely be determined. In the
great majority, however, the actual cause can-
not be ascertained. There are, nevertheless,
a number of etiological factors which play a
role in the genesis of many such cases, the
actual degree of importance or the mecha-
nism of action of which may not be com-
pletely clear. It is desirable to evaluate these
factors which may be operative singly or in
combination in the clinical study of any
given patient.
They may be grouj^ed under several head-
ings :
I. Renal, Factors.
(a) Benal Ischeynia from Extrarenal
I'nterference ivith Blood Flow.
A number of cases of hypertension have
l)een reported^^ in which the renal arteries on
one or both sides were partially occluded by
arteriosclerotic plaques or some other cause
such as tumor tissue. Blackmaid^ has re-
ported a study on autopsy material of the
caliber of the renal arteries. He found sten-
osis of one or both vessels in 86 per cent of
50 hyj^ertensive cases and in only 10 per cent
of an equal number of subjects who had had
The Journal of the Maine Medical Association
normal blood pressures. It is, of course, im-
possible to conclude with any certainty from
such a study that the hypertension was the
result of the arterial narrowing since the
sclerosis and stenosis of the renal vessels
might have been caused by and followed the
hypertensive process.
The hypertension occurring in coarctation
of the aorta is probably due to renal
ischemia.^
(h) Renal Isclie mia from Intrarenal
Disease.
It has been known for a long time that
glomerular nephritis, both acute and chronic,
is accompanied by hypertension; and the
high pressure of the chronic type, at least, is
certainly related to the renal lesion and prob-
ably to renal ischemia. Patients with poly-
cystic kidneys, renal tumors and rarely renal
amyloidosis may also develop hypertension,
and that seen in patients with periarteritis
nodosa and lupus erythematosus dissemina-
tus may also be on a renal basis.
From the practical point of view the most
significant recent contribution to this phase
of the subject was the demonstration by
A eiss and Parker^® of the frequency with
which hypertension develops in patients with
clironic or healed pyelonephritis, often years
after the infection itself had subsided. Hot
uncommonly such liypertension is of the “^hna-
lignant” type. In fact these authors estimate
that 15 to 20 per cent of persons with ‘hna-
lignant” hypertension have it as the result of
chronic or healed pyelonephritis, and such
pyelonephritis, or ‘^pyelitis” as it is still com-
monly called, when active need never have
been very severe or jDrolonged.
Some light on why some patients with
renal disease, such as pyelonephritis, develop
hypertension and others do not, is shed by
the study of Hines and Lander.^® They
found that patients with such renal disease
who developed hypertension usually had had
g high normal pressure at the time of, or be-
fore, the original renal infection whereas
those who did not develop high blood pres-
sure had had low normal pressures. In other
words, disease of this type produced hyper-
tension only in those persons who had a con-
stitutional predilection for it.
Nineteen Hundred and Forty-two — December
267
The clinical importance of these investiga-
tions is mainly two-fold. First, it is an added
reason for vigorous treatment and prolonged
follow-np of patients witli even apparently
minor urinary tract infections. With the
effective drugs now at onr command, the in-
fection in most of such patients can be
stopped promptly. It should always be re-
membered, however, that recurrences of uri-
nary tract infections are common.
Second, hypertension may have developed
as the result of unilateral renal disease, and
may be relieved by the removal of the affected
kidney. Several such successes have been re-
ported,’^ mainly in cases of unilateral pyelo-
nephritis. Such dramatic results are, how-
ever, not common and a number of recent
reports’® stress the infrecpiency with which
nephrectomy abolishes hypertension. This is
probably because the investigative methods
which we possess are not sufficiently delicate
to reveal the presence of the underlying dis-
ease in the other kidney or l^ecanse the hyper-
tension may have persisted so long that it in
turn had produced vascular changes which
were irreversible.
II." Endocrine Factors.
Certain tumors or dyscrasias of the ad-
renal gland, both cortex and medulla, may be
associated with hypertension. Pituitary d_ys-
fniiction and neoplasms, notably basophilic
adenoma, also bear an etiological relationship
to high blood pressure. The significance of
ovarian dysfunction to hypertension is less
clear. Certain it is that at the time of the
menopause hypertension first appears or be-
comes aggravated in many women and this
hypertension is frequently benign and in fact
may sometimes diminish as the climacteric is
passed.
It has been recognized for many years that
obesity and high blood pressure are com-
monly associated. Pobinson and Brucer’®
have recently shown that body build is even
more important, since wide-chested individ-
uals are much more prone to the development
of high blood pressure than those with nar-
row chests. Whether there is an endocrine
factor involved here is as yet undisclosed.
III. Hereditary Factor.
The factor of heredity has been the subject
of a good deal of study'” and the conclusion
is inescapable that there is a strong heredi-
tary tendency for the transmission of hyper-
tensive disease, so much so that persons with
hypertension have a positive family history
of cardiovascular disease in 86 per cent of
cases, compared to an incidence of 17 per
cent for individuals with normal blood pres-
sures. It is possible that the trait is inherited
as a dominant characteristic.
It is therefore evident that there are a
number of factors which are known to play
a role in the etiology of hypertension. These
may act singly or in combination. It must
be admitted, however, that the ultimate ex-
planation of the cause of hyjiertension in the
majority of patients is still imknown.
Medical Treatment of Hypertension
Xo significant advance in the medical
treatment of hypertension which is of prac-
tical use has been made in recent years.
The recently reported use of renal extracts is
suggestive and promising but this form of
treatment is still distinctly in the experi-
mental stage and it will be some time yet be-
fore it can be said whether it is clinically
practicable. There has been some revival of
interest in the use of thiocvanates recentlv,
V t/ /
and reports of success in a considerable per-
centage of cases both in relieving symptoms
and in reducing blood pressure. But reports
of the toxic effects have also appeared with
disturbing frequency. It is the opinion^’ of
those who have considerable experience in
thiocyanate therapy that these drugs are toxic
and if they are used rejieatedly determina-
tions should always be made of the patient’s
blood thiocyanate level. Because of the tox-
icity of the drug and the care with which pa-
tients receiving it must be followed, its use
is limited to a relatively small group of cases
with severe hypertension and mainly those
with intractable symptoms.
There is no drug or substance which is
clinically available which has been proven to
induce a prolonged lowering of elevated
blood pressure by a restoration to normal of
268
The Journal of the Maine Medical Association
circulatory dynamics. Drugs which are use-
ful are mainly sedatives, the effectiveness of
which resides in their action on the nervous
^nd not on the vascular system. The medical
treatment of hypertension, therefore, comes
down essentially to the general management
of the patient, to teaching him to live within
his reserves and to relax mentally and physi-
cally, to removing burdens on the circulation,
and to the watching for and treatment of
complications in their incipiency.
Surgical Treatment of Hypertension
Several surgical procedures for the relief
of hypertension have been proposed during
the last few years. The operation which is
most widely advocated is some form of
splanchnic sympathectomy which may or
may not be combined with resection of vary-
ing amounts of the lower dorsal and lumbar
sympathetic chains. A number of enthusias-
tic reports have been published concerning
the operative treatment,^^ as well as some
which are more critical.^®
It is always difficult to appraise the results
of any treatment for hypertension. It is a
condition which is chronic and subject to
great spontaneous fluctuations and even re-
gression and disappearance. Patients are
often favorably influenced by the psychic
effect of treatment enthusiastically given, es-
pecially if it is dramatic in nature. Obvious,
non-specific events, such as incidental opera-
tions for some other disease^^ may reduce the
hypertension. The literature of the last years
is filled with papers citing the beneficial
effects of all sorts of medicinal treatments.
In a short time such therapy is usually justi-
fiably discarded.
The problem of assessing the results of sur-
gical procedures is further complicated by
the multiplicity of operations that have been
advocated, the comparatively short length of
time many of the patients have been followed,
and the lack of theoretical rationale for the
operation. These operations were originally
introduced on the theory that increased vaso-
motor activity which was involved in the
pathogenesis of the disease would be abol-
ished in a laxge vascular area. There is at
present no convincing evidence that a height-
ened vasomotor activity plays any important
causative role in the disease. It has recently
been put forward by some that these opera-
tive procedures are effective by improving
renal blood flow, but further evidence in
favor of this concept must be furnished. Cor-
coran and Page,^^ on the other hand, found
po increase in renal blood flow in two pa-
tients studied by them before and after opera-
tion. The more conservative of the advocates
pf surgery admit the procedure is to be
judged on an empirical basis and may be but
a palliative measure. Judgment of the ulti-
mate value of the surgery is, moreover,
made difficult because of the lack of an ade-
quate amount of physiologic study regarding
what effect the operation has on the dynamics
of the circulation especially in the unsympa-
thectomized regions. It has not yet been dem-
onstrated that blood flow to these parts of the
body may not be impaired.
Against all this negative criticism one can
place the empirical evidence of the results.
Those cases which are most impressive are
the occasional patients with malignant hyper-
tension in which the disease process has defi-
nitely regressed for months or years, because
if any certain statement can be made about
the course of malignant hypertension under
medical treatment it is that it is a progressive
condition to an early termination in death.
At the present time, therefore, the surgical
treatment of hypertension should be con-
sidered in the experimental stage, and the
procedures when done should be carried out
only by surgeons who are particularly study-
ing the condition and are trained in the
operative technique. As regards advocating
it for one’s patients, it is my opinion that it
is justifiable for patients with malignant
hypertension, or severe benign hypertension
with intractable and incapacitating symp-
toms. These patients have nothing to expect
from medical treatment and a poor life ex-
pectancy, and a few of them may gain symp-
tomatic relief for a few months or longer and
even improvement in cardiovascular status
after a radical sympathectomy. I do not be-
lieve that it is advisable for patients with
hypertension of less severity, for they have
a fair to good prognosis under medical man-
agement and we do not know what the next
few years may offer for them either as to spe-
Nineteen Hundred and Forty-two — December
cific medical treatment or a standardized
operation whose effectiveness is definitely
known. It should be further borne in mind
that the extensive sympathectomies which are
being advocated require a high degree of
specialized surgical skill and knowledge, and
post-operatively the patients are at least par-
tially invalided for some months.
Summary
Recent advances in our knowledge concern-
ing hypeidension, both experimental and
human, have been summarized, especially as
regards etiology and treatment. It is to be
emphasized that although there is increasing
knowledge regarding the etiological factors
involved in the production of hypertension,
the ultimate cause of the greater majority of
instances of human “essential” hypertension
is still unknown.
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269
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The Journal of the Maine Medical Association
(g) Koons, K. M., and Ruch, M. K. : Hyper-
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(b) Palmer, R. S.; Chute, R.; Crone, N. L.,
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to Glomerulonephritis, as Revealed by
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Cases Treated by Bilateral Supradia-
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of Splanchnic Nerve Resection on Pa-
tients Suffering from Hypertension. Am.
J. Med. 8c., 193:820, 1937.
(b) Rytand, D. A., and Holman, E.: Arterial
Hypertension and Section of the Splanch-
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24. Volini, I. F., and Flaxman, N.: The Effect of
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The Platform of the American Medical Association
The American Medical Association advocates:
1. The establishment of an agency of the fed-
eral government under which shall be coordinated
and administered all medical and health functions
of the federal government exclusive of those of the
Army and Navy.
2. The allotment of such funds as the Congress
may make available to any state in actual need,
for the prevention of disease, the promotion of
health and the care of the sick on proof of such
need.
3. The principle that the care of the public
health and the provision of medical service to the
sick is primarily a local responsibility.
4. The development of a mechanism for meet-
ing the needs of expansion of preventive medical
services with local determination of needs and
local control of administration.
5. The extension of medical care for the in-
digent and the medically indigent with local de-
termination of needs and local control of adminis-
tration.
6. In the extension of medical services to all
the people, the utmost utilization of qualified med-
ical and hospital facilities already established.
7. The continued development of the private
practice of medicine, subject to such changes as
may be necessary to maintain the quality of medi-
cal services and to increase their availability.
8. Expansion of public health and medical serv-
ices consistent with the American system of
democracy.
Nineteen Hundred and Forty-two — December 271
The Freudian Theories
Section I: Definitions
Bv Tseaet. N^EWMAisr, M. D., Augusta, Maine
The purpose of this paper is to summarize
the Freudian theories in as few words as
possible, and yet not omit any of their basic
elements. To assime himself and the reader
against the creeping in of any possible misin-
terpretation for the sake of criticism, the
writer has constructed this article mainly out
of the writings of Freud and those of his ac-
credited followers. These quotations, calling
for a context in keeping with their tenses
(some in the present tense, some in the past),
necessitated the special arrangement of the
material.
In keeping with his theories Freud classi-
fied the PsYCiioxEUEOSES in his own distinc-
tive manner — to be cited later. For the sake
of comparison we will give a brief summary
of the symptomatology of these ailments as
classified before the introduction of the
Freudian hypotheses: —
In Hysteria one finds : paralyses ; epilep-
tiform seizures ; tics ; attacks of asthma ;
characteristic anesthesias ; atrophies due to
disuse ; the formation of blisters ; cyanosis of
j)arts ; amnesias ; paroxysms of laughing and
crying or of exultations and depressions ;
multiple personality.
In Helteasthexia there are motor and sen-
sory fatigability ; difficulty at concentration ;
headaches ; backaches ; anorexia ; insomnia ;
some emotional depression ; maii}^ somatic
complaints in the absence of clinical findings
to justify them.
PsYCir ASTHENIA is characterized by the
perseverance in mind of certain ideas (obses-
sions), urges to do certain things (compul-
sions), fears of certain things or places (pho-
bias) and anxieties.
According to Freud, not everything which
constitutes mind (or soul) is in conscious-
ness ; the main portion of the soul, including
the affects (feelings and emotions), is in the
unconscious. Freud also analyzes the soul as
made up of the Id (it), the Ego (I) and the
Superego. The ego and superego are partly
in consciousness and partly in the uncon-
scious.
Back of all things, deep in the unconscious,
is the id. The id knows only craving for the
satisfaction of its wishes, knows onlv the
Pleasuee-Pain Principle ; has no consid-
eration for the conditions of the outer world
wherein the immediate satisfaction of its
urges may result in disaster. More outward
is the ego. The latter is dominated by the
Reality-Principle. It derives its energy
from the id. It aims to carry out the wishes
of the id, but takes into consideration the con-
ditions of the outer world. Part of the ego is
in the unconscious. The superego is derived
from the ego. Its chief function is its criti-
cism which creates in the ego an unconscious
sense of guiilt. The superego is the permanent
expression of the influence of the parents. It
is to a great extent unconscious.
The Libido (lust). In so far as one can
infer the libido is the great source of energy
residing in the id. The libido, as Freud un-
derstands it, is practically identical with the
sex urge. But “sexuality,” says Freud, “is a
more comprehensive bodily function having
pleasure as its goal and only secondarily com-
ing to serve the ends of reproduction.”^ The
psychoanalysts have broadened the concept of
sexuality to include any hedonistic tendency
— to include even such physiological func-
tions as the emptying of the bladder or the
bowels.
The libido of the infant is first directed
towards its own body — pleasure is derived
from the functioning of the various organs
(organ eroticism) ; later it is directed
towards the personality as a whole (the auto-
erotic or narcistic stage) ; later still it is di-
rected towards a member of the family of
the same sex as its own (the homo-sexual
stage) ; later still — towards a member of the
family of the opposite sex (the hetero-sexual
stage).
Regarding sex Freud says : “We have a
large number of component instincts arising
from the various parts of the body, which
strive for satisfaction more or less indepen-
• dently of one another and find satisfaction
in what may be called organ pleasure. The
genitals are the latest of these erotogenic
zones . . . Many of them are put aside . . .
Some of them are defiected from their aims
. , . Others persist and play minor parts . . .
of arousing love . . . The course of develop-
ment : . . . The first of these pregenital phases
is called the oral phase ... In the second stage
the sadistic and a^ml impulses come to the
fore . . . Third comes the phallic phase.’'^
Early in life there is a diffuse distribution of
the libido ; later it becomes localized at differ-
ent areas: oral, anal and genital.
The libido may become arrested at any of
its developmental stages. An arrest of this
sort is termed Fixation. Thus there may be
fixation at the homosexual phase with the re-
sult of a corresponding perversion. There
may be mother-fixation, father-fixation, etc.
Similarly, if during early development a part
of the body has been too frequently stimu-
lated, the result may be, not only the predomi-
nance of this part in libidinal interest, but
also the development of a special type of char-
acter. Thus psychoanalysts speak of oral,
anal, muscle-, skin- or eye-erotic characters.
“The direction of the libidinal flow is con-
stantly changing. It may, for example, be
directed inwards (object love and narcism) :
it may be arrested in its forward flow (fixa-
tion) ; or it may flow to levels representing
earlier stages of development (regression) ;
or it may become dammed up (repression) ;
or it may be deflected into other more socially
acceptable channels (sublimation).”^
Cathexis is the “concentration of psychic
energy in a particular channel or place, li-
bidinal or non-libidinal.”^ Thus Ego-cathexis
means “libido directed towards the self”
(Ego-libido-narcism)
Since the concern of the id, dominated by
the pleasure-pain principle, is solely the satis-
faction of its urges, and the concern of the
ego is adaptation to the conditions of the
The Journal of the Maine Medical Association
outer world, there are frequent conflicts be-
tween these elements. The result is either of
the following : —
Sublimation. “Sublimation is the ex-
change of infantile sexual aims for interests
and modes of pleasure-finding which are no
longer directly sexual although psychically
related, and which are on a higher social
level. The terms, ^desexualized’ and ^aim-in-
hibited’ . . . describe sublimated activities.
Sublimation is essentially an unconscious
process.”^ “The satisfaction of one impulse
can be substituted by the satisfaction of that
of another.”^ (Except in the case of hunger
and thirst). “The relations of an instinct to
its aim and to its object are also susceptible
to alterations; both can be exchanged for
others ; but the relation to the object is the
more easily loosened of the two. There is a
particular kind of modification of aim and
change of object, with regard to which social
values come into the picture ; to this we give
the name Sublimation. We also have
grounds for the differentiation of what we
call ^aim-inhibited’ instincts; these proceed
from familiar sources and have unambiguous
aims, but come to stop on their way to satis-
faction with the result that a permanent ob-
ject-cathexis and an ennduring driving force
come into being. Of such a kind is, for in-
stance, the feeling of affection, whose source
undoubtedly lies in sexual needs, but invari-
ably renounces their gratifications.”^
Another possible outcome of the conflict is
Repression. In the case of a conflict between
the instinct and the ego, if the two “would
struggle with each other for some time in the
fullest light of consciousness until the in-
stinct was repudiated and the charge of
energy withdrawn from it, this would have
been the normal solution. But in neurosis
(for reasons still unknown) the conflict found
a different outcome. The ego drew back, as
it were, after its first shock of its conflict
with the objectionable impulse and debarred
the impulse from access to consciousness and
from direct motor discharge, but at the same
time the impulse retained its full charge of
energy. I named this process Repression.”^
The repressed impulse does not remain
inert, but continues to be active in the uncon-
Nineteen Hundred and Forty-two — December
scious. It keeps struggling to force its way
into consciousness, but is held back by the
Censor.
The censor is a function of the ego.® It is
the agency in the unconscious which prevents
unpleasant and repulsive ideas from entering
consciousness. But these urges of the id do
succeed in entering consciousness when dis-
guised. The disguises are various ; they may
consist of ideas, images, symbols, tendencies
and wishes of all sorts. An idea-group con-
stellated about an emotion is a complex.
When a complex enters consciousness in dis-
guise its energy is drafted off. Thus such a
procedure has the function of a safety-valve.
Suppose the illicit urge is that of incest. It
may take the form of an urge to go swimming
(if water symbolized the person desired).
The substituted act is in such an instance a
compromise whereby the id is satisfied and
there is no harm done.
Compromises of the above type constitute
the phenomena of Dreams. “In every dream
an instinctual wish is displayed as fulfilled.”®
The dream wish is usually a sexual one ; but
it may also consist of a non-sexual repulsive
desire the consciousness of which would hor-
rify the ego. The wish is, therefore, dis-
guised as something acceptible. Accordingly,
the dream is made up of the Manifest Con-
tent, the presented imagery which consti-
tutes the mask, and of the Latent Content
— of that which is behind the mask. In the
dream “the isolated thought is found to be an
impulse in the form of a wish, often of a very
repellent kind . . . This impulse . . . makes
the use of the day’s residue as material ; the
dream which thus originates represents a
situation in which the impulse is satisfied . . .
The unconscious impulse makes use of this
nocturnal relaxation of repression in order to
push its way into consciousness with the
dream. But the repressive resistance of the
ego is not abolished but merely reduced.
Some of it remains in the shape of censorship
of dreams and forbids the unconscious im-
pulse to express itself in the form which it
would properly assume. In consequence . . .
the latent dream thoughts are obliged to sub-
mit to being altered ... We are, therefore,
justified in asserting that a dream is the ( dis-
guised) fulfillment of a (repressed) wish . . .
273
Ilie general function of dreaming: it serves
the purpose of warding off, by a kind of
soothing action, external and internal stimuli
which would tend to arouse the sleeper . . .
External stimuli are warded off bv beiiia;
given new interpretations . . . Internal stimuli
caused by the pressure of the instincts are
given free play by the sleeper and allowed to
find satisfaction in the formation of dreams
so long as the latent dream thoughts submit
to the control of the censorship. But if they
threaten to break free and the meaning of the
dream becomes too plain, the sleeeper cuts
short the dream and awakens in terror.
(Dreams of this class are known as anxiety
dreams).”^ “There is no contradiction of this
function in the fact that the dream sometimes
wakes the sleeper in a state of anxiety; it is
rather a sign that the watcher regards the
situation as being too dangerous and no
longer thinks he can cope with it.”® “Even
2)unishment dreams are wish-fulfilling, but
they do fulfill the wishes of the instinctual
impulses but those of the critical censuring
and punishing functions of the mind.”®
Among the various processes by means of
which the dream is distorted Freud mentions
Condensation, as the condensation of two or
more persons into one, and Displacement of
the accent so that the significant appears as
the insignificant part of the dream. In
dream-work the affects (which give the ac-
cents) are separated from the ideas and may
be transferred to other ideas.
Similar transformations and expessions of
unconscious wishes occur in Symptomatic
Acts, that is, in such acts as slips of speech,
mislaying of objects, etc. The consciously
loyal host, for instance, may, as the result of
an unconscious wish, the admission of which
the ego would not tolerate, accidentally in-
troduce his guest, the crown prince, as the
“clown prince” which, as a slip of the tongue,
is readily overlooked.
Unconscious impulses occasionally find ex-
pression in the form of such symptoms as
constitute the neuroses and the psychoneu-
roses. When the urge of the id is strong and
the ego feels too weak to cope with it, the ego
“makes an attempt at flight, deserting this
specific part of the id, it refuses all such as-
sistance as it usually renders to urges rising
274
The Journal of the Maine Medical Association
from the id. We refer to such cases as repres-
sion of the urges by the I . . . The isolated
urge . . . contrives to compensate itself by
engenderinng psychical derivatives which
take its place and, connecting with other
psychical derivatives, estranges them to the
I. Finally in the form of an unrecognizable
substitute the isolated urge penetrates the I
and to consciousness presenting itself as what
is known as a symptom . . . the id taking re-
venge on the I. This revenge of the id on the
I results in nothing else than a- neurosis.’’^
A process of the above type is evident in
hysteria wherein there is the conversion of
the urges into symptoms. Conveesion is
“the symbolic expression by means of physi-
cal manifestations (motor or sensory) of both
repressed instinctual wishes and the defense
set up against them . . . Hysterical symptoms
mean that the repression has been unsuccess-
ful and the affective energy of what is re-
pressed radiates into the body sphere.’’^
“Conversion hysteria genitalizes those parts
of the body at which the symptoms are mani-
fested.” (Ferenczi).
Thus when the energy of the repellant urge
becomes converted into body sjunptoms the
result is Coxveesiox Hysteeia. But if it
happens that some or all the energy is left
unconverted it turns into a sense of anxiety
which is “free floating,” that is, not an
anxiety over this or that possibility, but just
a sense of anxiety whicb has no particular
object. In the case of hysteria this free-
floating anxiety soon becomes attached, that
is, associated with some object or idea. It ac-
cordingly becomes a Phobia. Thus the symp-
tom-group designated as phobias, which
others include under the symptomatology of
psychasthenia, is distingiiished by Freud as
a separate entity which he names Anxiety
Hysteeia. “This projection occurs because,
of tbe anxiety which conscious realization of
a repressed wish would entail. The phobia
may also represent a repressed complex whose
affective tone has become detaches and shifted
into an idea which bears relation to the un-
conscious one, minus the sexual connotation.
But whether sexual or not, the interpretation
is that all phobias represent an unconscious
sense of gaiilt attached to an early memory
, . . Hysterical Anxiety ... is not directly de-
pendent upon frustration from without and
... it may even undergo conversion.”^
Before discussing the other neuroses we
must mention the evolutional changes which
occur in “practically all neuroses
1. “Failure of adjustment to difficult situ-
ations in adolescent or adult love brings about
an external conflict. This, in the constitution-
ally predisposed individual, constitutes the
precipitating trauma.
2. “Inability to settle the conflict in terms
of reality necessitates withdrawal into phan-
tasy which implies regression to various
levels of infantile fixation. The decree
o
varies . . .
3. 'depression, or the exclusion from con-
sciousness of unconscious infantile wishes.
4. “Rejiression in turn leads to inner con-
flict. The conflict may be resolved in one of
a number of ways. There may be successful
repression or sublimation and the elimination
of the conflict. The conflict may be resolved
l)v means of inner dissociation and the forma-
tion of symptoms. The inner conflict may
lead to further repression and the shifting of
the iingratified wishes to ever lower levels.
This in turn keeps up that imier fermenta-
tion which leads to anomalies of conduct
whose motive is obscure. Parenthetically it
may be pointed out that in the neuroses the
liliido may regress to the lowest level of what
is known as object-flxation, namely the sec-
ond phase of sexual development. Where the
regression proceeds to the narcistic stage and
the libido so to speak becomes attached to the
ego, the result is a psychosis.”^
Before proceeding farther we must clarify
the term Teawsfeeexce used in connection
with neuroses : “The ability to shift the ob-
ject-libido or to transfer’ it from one person
to another is known as Teansfeeence . . .
Transference is looked upon as a love rela-
tionship though it may be either positive or
negative . . . The loose attachment of the ob-
ject-libido and the possibility of shifting it
more or less easily are regarded as character-
istic of certain neuroses (particularly of
hysteria).”^
The other symptom-group, included under
psychastenia, which Freud identifles as a dis-
tinct entity is that of the compulsions. Freud
Nineteen Hundred and Forty-two — December
terms this group as Compulsion Neuroses.
“In the case of the hysterical symptom the
repression extends only to the state of dn-
cestnons’ fixation, while in compulsion neu-
rosis there is further regTession to an earlier
narcistic stage . ... The compulsive act is
more of a defense reaction.”^ “It too then is
a transference neurosis.” “Few or none are
cured though the symptoms are removed . . .
The compulsion mechanism is . . . not a ful-
fillment of an unconscions wish . . . The cere-
monial elaborated by tbe compulsive neurotic
absolves and protects from consciousness of
guilt. In other words, these compulsions
and obsessions serve the patient to keep the
mischief out of his mind.
Another type of anxiety Freud identifies
as Anxiety Neurosis. This neurosis is the
result of frustration of excited sex urges.
Freud’s Classificatiox^ of the Neu-
roses : —
A. Actual Neuroses.
I. Anxiety Neurosis.
II. Neurasthenia.
III. Hypochondria.
IV. Traumatic Neurosis (The inclu-
sion of this neurosis here is not
fully determined).
B. Psychoneuroses: Regression Neu-
roses OR Fixation Neuroses.
I. Transference Neuroses.
a) Hysteria.
1. Conversion hysteria.
2. Anxiety hysteria.
b) Compulsion neurosis.
II. Narcistic Neuroses (psychoses).
a) Paraphrenia.
b) Schizophrenia.
c) Manic-Depressive.
d) Paranoia.
III. Other Regression Neuroses.
a) Perversions.
275
b) Neurotic Character.
1. Introvert, Schizoid.
2. Extravert, Cycloid.
C. Mixed Neuroses.
D. Borderline Cases.
“Actual neuroses are characterized by
physical and physiological disturbances . . .
May be regarded as illustrations of mixtures
of psychogenesis and organic pathogenesis.”^
The development of the anxiety neurosis,
as described by Freud, is a very complicated
one. We will give only the essentials. “We
have discovered two new facts,” says Freud,
“first that anxiety causes repression and not
the other way around, as we used to think,
and secondly that frightening instinctual sit-
uations can in the last resort be traced back
to external situations of danger.”^ In the
“development of anxiety in anxiety neurosis
caused by somatic injury of the sexual func-
tion . . . (there is the) twofold origin of the
anxiety : first the direct effect of the trauma
itself, and secondly, as a signal that a somatic
factor of this kind threatens to occur.”" The
gist of the situation is as follows : When an
illicit wish threatens to invade, “the ego be-
comes aware that the satisfaction of some na-
scent instinctual demand would evoke one
among the well-remembered danger situa-
tions. This instinctual cathexis must in some
way or other by suppressed, removed, made
powerless. Now we know that the ego suc-
ceeds in this task if it is strong . . . (But if)
the ego feels weak. In such a contingency,
the ego calls to its aid a technique which at
the bottom is identical with that of normal
thinking. Thinking is an experimental deal-
ing with small quantities of energy, just as
a general moves miniature figures about over
the map before setting his troups in action.
In this way the ego anticipates the satisfac-
tion of the questionable impulse.”" This an-
ticipation is enough to recall the castration
situation which, of course, gives rise to
anxiety. When this anxiety develops “the
pleasure-pain principle is brought into play
and carries through the repression of the dan-
gerous impulse.”" .
(To he continued in the January issue)
276 The Journal of the Maine Medical Association
Editorial
Civilian Medical Care
The program for civilian medical care is
fast shaping up to the pattern which it will
follow for the duration, and which needs and
must have the whole hearted support of the
public. Conservation of medical service hy
the civilian population is as essential to the
success of the war program as conservation of
commodities such as are now rationed. The
civilian knows that practically every physi-
cian under 45 years of age, who is physically
fit, is now serving with the armed forces, hut
does not seem to realize what this means to the
physician on the home front who is doubling,
and in many cases tripling, his efforts.
There are many ways in which the public
can be instructed to cooperate with the physi-
cian. We suggest a few which if brought to
the attention of the public will undoubtedly
be gratefully received when they realize that
their cooperation will mean conservation of
the limited Supply and time of doctors for the
most efficient service.
One of the most important is night calls ;
never call a physician during the night unless
it is absolutely necessary, remend^er that the
doctor must have his rest if he is to keep at
the peak of his efficiency. When a house call
is necessary call the physician as early in the
day as possible in order that he may route his
calls ; remember that the physician is also ra-
tioned in the use of gasoline and rubber, also
that he must make every minute of his day
count. Whenever possible go to the doctor’s
office instead of calling him to the home; “An
ounce of prevention is worth a pound of
cure,” and consulting your physician at the
first sign of illness often prevents a long and
serious illness. Make every effort to prevent
illness, accidents, and the spread of communi-
cable diseases. The sacrifice of the doctor on
the home front is as great as that of his col-
league in military service with none of the
glory, and without benefit of military in-
signia, remember this when inconvenienced
by having to make a change in doctors, or
when finding it difficult to get a doctor “right
away.” Remember, too, that the workers in
the industrial plants are also dependent on
the doctors on tlie home front. The impor-
tance of this phase of the war program cannot
be stressed too much. These workers have got
to be kept on the job to keep our armed forces
supplied with war implements and supplies.
We feel that it must be a comfort to the
members of the civilian population to know
that the men in our armed forces are receiv-
ing adequate medical care, no matter where
stationed, particularly those civilians who
have relatives in the service. There are at this
time enough physicians in the armed forces,
but the first of the year it will again be neces-
sary to call on the members of the medical
profession for more doctors to meet increas-
ing military needs, which will mean an even
greater burden for the already overburdened
doctor at home. But the civilian j)opulation
will continue to receive adequate medical care
if they will give adequate cooperation in con-
serving medical service.
Nineteen Hundred and Forty-two — ^December
277
Maternal and Child Welfare
BEEAST EEEDIJTG
A discussion of breast feeding calls to my
mind Mark Twain’s remark about the
weather: “Every one talks about it but no
one seems to do anything about it.” I sup-
pose that even in these days of almost miracu-
lous achievements, it is still difficult to do
very much al>out the weather. It is not diffi-
cult, however, for doctors to do something
about breast feeding, and right now is a good
time to do it.
It is agTeed, generally agreed, that human
milk offers the best nourishment to human
babies. IMother’s milk is specific for her baby.
The outstanding characteristics of breast milk
are well known to all practicing physicians.
Let me review a few :
1. It is warm, fresh and free from all
harmful bacterial contamination and passes
directly from mother to baby. Has a specific
gravity of around 1030 and a caloric value of
about 20 calories to the ounce.
2. It is liquid and remains nearly liquid
in stomach. Although it coagulates in stom-
ach, the curds are fine, soft, flocculent and
permeable to gastric juices.
3. It contains the essential food elements
in natural and therefore ideal proportions,
both as to quality and quantity.
The average representation of the different
food elements is about as follows; fat — 1%,
protein — 1.25%, lactose — 7%, mineral salts
— 0.23%, water — 87.7%.
4. It contains all the vitamins that are
essential in early infancy, hoth as to kind and
quantity, provided the mother’s diet is ade-
quately balanced.
The above statements are taken from Bren-
neman’s “Practice of Pediatrics” and were
written by Dr. Brennenian.
If we accept these statements as facts, and
we do, why don’t we insist on Breast
Eeeding ?
Grulee, writing in the A7nerican J ow'nAl
of Diseases of Children (58 :l-7), July, 1939,
says : “Nature’s method of nourishing babies
with breast milk has for generations produced
excellent results” — Even thoTigh the in-
creased use of anesthesia and sedatives in
labor has resulted in a certain lethargy on the
part of the child, most mothers can nurse
their babies if they wish and if they are
urged. There seems to be an attitude of de-
featism toward this subject.” Here is boldly
stated what most of us must feel to be the
truth of the matter.
To date there has appeared no scientific
evidence to prove that mothers have deterio-
rated as milk producers. There are some
signs, however, that mothers don’t want to
nurse their babies and that the doctors do not
urge them to start on the breast feeding. The
answer to the question, “Why don’t we as
doctors insist on breast feeding,” seems to be,
then, that the mothers are allowed to go on
thinking that some artificial food is just as
good or better. That state of mind in the
mother, it seems to this writer, should be over-
thrown by the physician who is in attendance
during the pregnancy. It is not easj^ to per-
suade one of these mothers after her baby is
born that she should start breast feeding. She
has been coasting along for eight or nine
months on the assumption that the baby could
have a formula and that she, the mother,
would be relieA^ed of the “cares” of breast
feeding. The time to start breast feeding, at
least to sow the seed, is when the mother first
consults the physician. If the mother, during
her pregnancy is told about the advantages of
breast feeding, she will much more readily
adopt it when the bahy is born. But this early
conviction and ready adoption often melts
away shortly after delivery, unless strong sup-
port for breast feeding is maintained all along
the line.
Two causes for early abandonment of the
breast appear in many, many cases : First,
the fact that the gain is not always rapid and
sustained. The report of your Committee of
Maternal and Child Welfare for November,
1942 (published last month), states the case
clearly. Mothers must be assured that the
278
rapid gain is not the one and only indication
of healthy gTOwth and progress.
Second, the fact that after discharge from
hospital and establishment at home the baby
cries ‘boo mnch.” This seems to be the criti-
cal period. The mother no longer has the
benefits of special hospital care. She has,
moreover, some of the responsibilities of the
home on her shonlders. She fails to rest as
mnch as she slionld and the hahy often shows
the effect of these changes by developing indi-
gestion, gas, and sometimes colic. If every-
one, at this time, will exercise patience, pro-
vide more rest for the mother, and quiet down
the honsehold, the j^eriod of disturbance will
pass and breast feeding be maintained.
As this is being written, a mother called up
to say that she couldn’t hny the evaporated
milk she was using in her baby’s formnla and
asked if any other would do. This morning
a young man connected with the baking in-
dustry reported that the dry milk producers
told him to expect about a 90% cut in dry
milk. Other materials are less abundant than
they were a year ago. They may not be any
more abundant next year. In certain areas
and under some conditions, a scarcity of
products may make breast feeding more es-
sential than it is at present. However that
The Journal of the Maine Medical Association
may be, no one knows definitely. But doctors
know that Breast Feeding is right and proper
for new horn babies. They know that it has
decreased in practice (One hospital in one of
onr larger communities reported four babies
out of twenty-eight on the breast). It has
never been proven that mothers are less able
today than they were 25 or 50 years ag'o to
nurse their young. Eeports from the medical
literature indicate that mothers do not seem
well informed about the merits of breast nurs-
ing and too much informed about the ease of
formula feedings ; that doctors do not seem to
urge breast nursing as strongly as they
should. Great benefits to new-borns would
follow cooperation between attending physi-
cian, nurses and mothers to revive breast
nursing during the early months. To con-
tinue breast nursing alone without the addi-
tion of foods at 3 and I months, without
orange juice and extra amounts of vitamins
A and D, is not called for in this discussion.
Prolonged milk diet, milk only, leads to anae-
mia, rhachitis and lowered resistance to infec-
tion. Breast feeding in the early months,
however, combats all of these.
Youe Committee ox Mateexal
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Reference; Maine Medical Association Secretary
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Nineteen Hundred and Forty-two — December 279
County News and Notes
Aroostook
The fall meeting of the Aroostook County Medi-
cal Society was held at the Plymouth Hotel, Fort
Fairfield, Maine, on October 15, 1942.
Dinner was served at 7.30 P. M.
Meeting called to order by President Thomas
Harvey at 8.30 P. M.
Welcome and introduction of guests by Presi-
dent Harvey.
All present stood for the minute of silence in
respect and memory of our recently deceased mem-
ber, Dr. Parker Ward, Houlton.
Delegates elected to Maine Medical Association
— Doctors Harvey and Doble.
Alternates elected — Doctors Swett and Kimball.
Invitation to all members of Aroostook County
Medical Society to attend staff meetings of Medi-
cal Corps of Presque Isle Air Base given by Major
Laird, M. C., U. S. A. This invitation was unani-
mously accepted.
PROGRAM
1. Breast Cancer — case presentations and movies
of surgical procedures — Bindley Dobson, M. D.,
Presque Isle.
2. Kenney Treatment of Poliomyelitis — W. E.
Sincock, M. C., U. S. A.
3. Sanitation Problems in Our Army — Major
Laird, M. C., U. S. A.
4. Diabetes Mellitus — case presentations — H. C.
Kimball, M. D., Port Fairfield.
Doctor Dobson’s paper brought out concise
methods of classification and diagnosis of cancer
of the breast and included X-ray plates showing
metastases to bones. He concluded with a splen-
did movie showing details of a surgical technique
in radical removal of the breast in operable cases
of carcinoma.
The several cases of diabetes mellitus presented
by Doctor Kimball were effective in showing some
of the more unusual findings that may be associ-
ated with this disease and presented detailed
courses of treatment for these conditions. One of
these cases showed an unusually high glycosuria
of 10% and went into surgery for emergency
femoral hernia without mishap. Another case was
in diabetic coma with a blood sugar of 533 mg. per
100 c.c. and received 420 units of insulin in a 7-hour
period. This condition was also corrected. His
summary — the severity of symptoms is not di-
rectly proportional to the amount of glycosuria.
The Kenney treatment in poliomyelitis is based
upon three conditions — (1) muscle spasm, (2)
muscle coordination, (3) mental alienation —
stated Doctor Sincock. He added that the prin-
ciples of this treatment depended upon early hot
packs followed by muscle training through mental
concentration upon passive movements and later,
active movements. The patient must always lie in
a straight position — never allowed on the side.
Details of this treatment may be obtained from
the National Foundation for Infantile Paralysis,
Inc., 120 Broadway, New York. City. There is no
known cure for real paralysis. Procedure in treat-
ment involves: (1) diagnosis, (2) complete rest,
(3) combat toxicity, (4) Kenney treatment, (5)
maintain morale.
The guest speaker of the evening, Major Laird,
M. C., Presque Isle Air Base, U. S. A., proved some-
what of a sensation by throwing a cliallencje into
the lap of the Aroostook County Medical Society.
In his very direct and forceful approach to the
local sanitation problems encountered at the local
COUNTY SOCIETIES
Androscoggin
President, Camp C. Thomas, M. D., Lewiston
Secretary, Charles W. Steele, M. D., Lewiston
Aroostook
President, Thomas G. Harvey, M. D., Mars Hill
Secretary, Clyde I. Swett, M. D., Island Falls
Cumberland
President, Roland B. Moore, M. D., Portland
Secretary, Eugene E. O’Donnell, M. D., Portland
Franklin
President, James W. Reed, M. D., Farmington
Secretary, George L. Pratt, M. D., Farmington
Hancock
President, Ralph W. Wakefield, M. D., Bar Harbor
Secretary, M. A. Torrey, M. D., Ellsworth
Kennebec
President, L. Armand Guite, M. D., Waterville
Secretary, Erederick R. Carter, M. D., Augusta
Knox
President, James Carswell, M. D., Camden
Secretary, A. J. Puller, M. D., Pemaquid
Linco In-Sagadahoc
President, Edwin M. Fuller, Jr., M. D., Bath
Secretary, Jacob Smith, M. D., Bath
Oxford
President, Lester Adams, M. D., Greenwood Mt.
Secretary, J. S. Sturtevant, M. D., Dixfield
Penobscot
President, Ernest T. Young, M. D., Millinocket
Secretary, Forrest B. Ames, M. D., Bangor
Piscataquis
President, Albert M. Cardy, M. D., Milo
Secretary, Harvey C. Bundy, M. D., Milo
Somerset
President, Maurice S. Philbrick, M. D., Skowhegan
Secretary, Maurice E. Lord, M. D., Skowhegan
Waldo
President, Lester R. Nesbitt, M. D., Bucksport
Secretary, R. L. Torrey, M. D., Searsport
Washington
President, Perley J. Mundie, M. D., Calais
Secretary, James C. Bates, M. D., Eastport
York
President, Carl E. Richards, M. D., Alfred
Secretary, C. W. Kinghorn, M. D., Kittery
280
The Journal of the Maine Medical Association
Air Base, he alleged to have proved conclusively
that the public water system of Presque Isle had
been, through its non-potability, directly respon-
sible for a serious epidemic of acute gasto-enteritis
at the Air Base lasting for over 9 months. After
considerable investigation by his Staff and Army
Engineers, he finally succeeded in establishing the
source of the infection and in convincing local and
State health authorities of the harmful nature of
the public water supply due to insufficient chlo-
rination. This has since been remedied by the
installation of needed filter equipment.
The problem, he said, was not completely solved,
however, since in the course of his investigations,
he found that the same conditions of unsafe and
unfit water for civilian use was also found in the
water systems of Caribou, Fort Fairfield, Mars
Hill, Grand Isle, and Houlton.
This is a most deplorable situation, especially
since it appears that a little more careful atten-
tion to chlorination would remedy the situation
and the Aroostook County Medical Society felt
that such apparent criminal negligence should im-
mediately come to the attention of the Public
Health authorities of the County and State.
Major Laird stated that as yet nothing had been
done by the Department of Health and he briefiy
summarized this unsanitary condition as arising
from: (1) improper methods of chlorination and
filtration, and (2) inadequate chlorination of the
public water supplies in these towns.
Meeting adjourned.
There were thirteen members and the following
guests present: Miss Sylvia Karatya (Fort Fair-
field Hospital) and the following officers from the
Medical Corps, Presque Isle Air Ease: Major
Laird, Capt. Eugene A. Andrick, Capt. James R.
Bell. Lt. H. Y. Twiss, Capt. A. L. Courville, Capt.
D. H. Maurey, Capt. F. P. Maibauer, Lt. I. Zeltzer-
man, Lt. E. Artman, Lt. W. M. Garrett, Lt. J.
Sang, Lt. J. N. Baum, Lt. H. T. Friedman, Capt.
Norman O. Eaddy, Capt. Joseph H. Nicholson,
Capt. Irving Pinsley, Lt. Chas. F. Banas.
Respectfully submitted,
Clyde I. Swett,
Secretary.
Knox
The regular meeting of the Knox County Medi-
cal Society was held at Rockland, Maine, on Tues-
day, November 10, 1942.
The meeting was called to order by Doctor
Carswell, president. Minutes of the last meeting
were read and after some discussion approved.
Doctor Jameson explained about the 1943 meet-
ing of the Maine Medical Society. All delegates
and alternates should go, as this is a business
meeting. Doctor Carswell reported on his presence
as a delegate at both meetings, and stressed the
importance of everyone possible doing so.
Doctor Jameson gave a very fine description of
Regional Ileitis, reviewed clinic findings, and
changes in treatment with the latest accepted
method. Doctor Carswell opened the discussion
and emphasized the obstructive aspect of chronic
cases with reasons for the obstruction.
Doctor Soule being unable to attend. Doctor
Foss, who was to open the discussion on Virus
Pneumonia, gave a nice talk with the symptoms
and clinic picture of the disease and treatments.
Doctor Allen read his notes on the case, and Doc-
tor Polisner commented on the cases he had at-
tended, making this newly recognized disease seem
one which we should readily recognize.
Both papers and discussions were very interest-
ing and beneficial.
Adjourned.
A. J. Fi ller, M. D.,
Secretary.
Penobscot
The annual meeting of the Penobscot County
Medical Association was held at the Bangor House,
Tuesday, November 17th.
Reports of the Secretary and Treasurer were
read and approved for file. Figures show present
membership of 92, with 16 already in military
service.
Officers were elected for 1942-43 as follows:
President — E. T. Young, M. D., Millinocket.
Vice-President — M. C. Moulton, M. D., Bangor.
Secretary-Treasurer — F. B. Ames, M. D., Bangor.
Board of Censors — P. S. Skinner, M. D., Bangor;
H. C. Scribner, M. D., Bangor; M. F. Ridlon, M. D.,
Bangor.
Delegates to Annual Meeting of Maine Medical
Association — E. T. Young, M. D., Millinocket; F. D.
Weymouth, M. D., Brewer; S. S. Silsby, M. D.,
Bangor; L, H. Smith, M. D., Winterport.
Alternate Delegates to Maine Medical Associ-
ation— M. C. Maddan, M. D., Old Town; C. E.
Blaisdell, M. D., Bangor; F. B. Ames, M. D., Ban-
gor; H. G. McKay, M. D., Old Town.
The paper of the evening was delivered by the
retiring President, A. W. Fellows, M. D., Bangor.
The subject of this most instructive discourse was
“The Ailing Child.”
The attendance was 34.
Forrest B. Ames, M. D.,
Secretary.
Somerset
At the annual meeting of the Somerset County
Medical Society, the following officers were elected
to serve for the coming year:
President — Maurice S. Philbrick, of Skowhegan.
Vice-President — Lester F. Norris, of Madison.
Secretary-Treasurer — Maurice E. Lord, of Skow-
hegan.
Board of Censors — Walter S. Stinchfield, of
Skowhegan; Ray C. Brown, of Bingham; Howard
Reed, of Madison.
Program Committee — Howard Reed, of Madison;
George E. Young, of Skowhegan; Maurice E. Lord,
of Skowhegan.
Delegates to the State Meeting — Walter S.
Stinchfield, of Skowhegan; H. E. Marston, North
Anson, Alternate.
Maurice E. Lord, M. D.,
Secretary.
Members in Military Service"^
Cumberland
Hanlon, Francis W., Portland
Hancock
Weymouth, Raymond E., Bar Harbor
* For complete list see September, October, and
November Journals.
Nineteen Hundred and Forty-two — December
281
Necrologies
Luther Grow Bunker, M. D.,
1868-1942
Luther Grow Bunker, M. D., 74, practicing physi-
cian for fifty years, died at his home in Waterville,
Maine, November 26, 1942.
He was born at Trenton, Maine, March 19, 1868,
the son of John E., and Mary Alley Bunker, and
was graduated from Bowdoin Medical School in
1892.
He began general practice at Sanford and North
Berwick in 1892, and moved to Waterville in 1895
where he remained to the time of his death.
Doctor Bunker served twelve years as a mem-
ber of the Board of Registration of Medicine in
Maine, and was a member of the Kennebec County
Medical Society, the Maine Medical Association,
and the American Medical Association. He was
also a member of the Odd Fellows, the Elks,
Knights of Pythias, Masonic bodies, and the
Kiwanis Club.
Doctor Bunker served as city physician for six
years and was mayor in 1907 and 1908.
At the June, 1942, annual session of the Maine
Medical Association, he was presented with the
Association’s gold medal in recognition of fifty
years in the practice of medicine.
Surviving are his widow, and a daughter.
Frank A. Ross, M. D.,
1873-1942
Frank A. Ross, M. D., 69, physician at South
Berwick, Maine, since 1904, died suddenly Novem-
ber 16, 1942. He had been in poor health but had
recovered sufficiently to receive patients at his
office.
Doctor Ross was born in Philadelphia, March 10,
1873, the son of Orrin S. and Clara Whitten Ross,
and was graduated from Bowdoin Medical School
in 1896. He was at Salem, Massachusetts, hos-
pital a year following his graduation and from
1897 to 1904 was on the medical staff at the Dan-
vers State Hospital, Danvers, Massachusetts.
He was a member of the York County Medical
Society, the Maine Medical Association, and the
American Medical Association. He was also a
member of the Dover, N. H., Lodge of Elks, South
Berwick Red Men, the Blue Lodge of Masons,
Shrine, and First Baptist Church. He was a trus-
tee of the Salmon Falls, N. H., Bank, and was for
many years chairman of the South Berwick board
of health.
Surviving are his widow, Mrs. Myrtie E. Ross,
and a daughter, Mary Elizabeth, who was gradu-
ated from the New England Baptist Hospital last
May.
Parker Myles Ward, M. D.,
1873-1942
Parker Myles Ward, M. D., died suddenly at his
home in Houlton, Maine, on September 8, 1942, of
a heart attack. Doctor Ward was graduated from
Harvard University in 1898. He returned to his
home town where he was in active practice for 44
years. In 1916 he began specializing in Eye, Ear,
Nose and Throat, taking extensive study in New
York City and in clinics in Europe.
Doctor Ward was a member of the Aroostook
County Medical Society, the Maine Medical Associ-
ation, the American Medical Association, and of
the Monument Lodge of Masons, the Meduxinekeag
Club, and the Unitarian Church.
He is survived by his wife, Diadama Sharpe,
and two sons, Wendell of Braintree, Massachusetts,
and Richard in the U. S. Army.
Robert James Wiseman, M. D.,
1871-1942
Robert James Wiseman, M. D., of Lewiston, died
November 20, 1942, in his 72nd year, following an
illness of several weeks.
Doctor Wiseman was graduated from Bowdoin
Medical School in 1903, as an honor student.
He established three drug stores in Lewiston,
and founded and operated the Priscilla Theater,
which he named after his daughter. He entered
politics in 1914, and was Mayor of Lewiston nine
times between then and 1934. As Mayor he took
special interest in welfare and public works, and
made many improvements in both departments.
He was a member of the Androscoggin County
Medical Society, the Maine Medical Association,
and the American Medical Association.
He if, survived by his widow, a daughter, and
three sons.
282
The Journal of the Maine Medical Association
PnxiceedUix^
NINETIETH ANNUAL SESSION
Mediocd Ai4oc4ati04i,
POLAND SPRING, MAINE
JUNE 21, 22, 23, 1942
CONTINUED FROM THE NOVEMBER ISSUE OF THE JOURNAL, PAGE 262
CiiAiiiMAN Stevens: Is there any further new
business to come before the meeting?
Dr. Frank A. Smith of Westbrook: It seems to
me that there is a great deal of routine that we
have to go through here in approving, which all
takes time. I have felt for several years that it
might facilitate matters if we had some scheme of
informing ourselves better of the questions that
are coming up.
I think it would be excellent if we could have
the Councilor in each district get together with
the delegates and the President and the Secretary
of the County Society, before our Annual Meeting,
so that if any questions were confusing, they
would be cleared up, and the delegates would have
a chance to talk things over that might be im-
portant.
Chairman Stevens: Thank you. Dr. Smith. Do
you wish to make any motion regarding this?
Dr. Prank A. Smith: I would like to hear the
sentiment of the other delegates.
Dr. Thomas A. Foster: I would like to say that
I am in accord with the idea. In the first place,
the delegates should be chosen with care. The
deliberations of the delegates make the policy of
the Association.
The delegates are chosen early; most of the
annual meetings of the counties come early. They
could he chosen with great care, and then called
together by the Councilor in that District, so that
the time of the House of Delegates would be saved
by the previous discussions of matters.
I approve of that suggestion.
Chairman Stevens: Are there any other sug-
gestions?
Dr. Albert W. Plummer: Do I understand from
Dr. Smith that the proposals that would be brought
up here should be brought to the attention of the
delegates through the Journal or earlier in the
season?
Dr. Frank A. Smith: I might say I know that
in our Society, a number of years ago, the dele-
gates met. Now, I am not criticizing anybody; it
is just the trend of the times, I think. But, we met
and talked over things, and we had perhaps two
or three meetings, and we talked over what was
coming up or what we thought ought to be brought
up to the attention of the delegates for the good
of this Association.
It might be weli to have a definite meeting, one
or more meetings, by the delegates of each county,
and to have present the Councilor from that Dis-
trict and the President and Secretary of that
County Society.
Chairman Stevens: You mean that each Dis-
trict would have a meeting prior to the House of
Delegates’ meeting?
Dr. Frank A. Smith: That each county society
would have a meeting of the delegates, together
with the Councilor and the President and Secre-
tary of the county society. I suggested that the
President and the Secretary of the County Society
would be there, too, as well as the delegates and
the Councilor from the District.
Of course, that is just a suggestion.
Dr. Carl E. Richards: Wouldn’t it be better to
unite each District’s delegates, and have them
meet with the Councilor for that District? It
would make it a little larger meeting, and you
would get a wider variety of subjects brought up.
Dr. Albert W. Plummer: I like the general pro-
posal of Dr. Smith’s and I think it could be worked
out in some way.
Of course, at times, there have been matters
brought up which were brought to the attention of
the different county societies, and I think that is
a very good idea.
Chairman Stevens: Is there any further discus-
sion or are there further suggestions?
Dr. Raymond L. Torrey of Searsport: I don’t
think the idea of saving time would work out be-
cause we have got extra meetings to attend, and
we would have to put in more time on the other
meetings than we would to hash things over here.
But, I think it would make for better efficiency at
this meeting, because the delegates are going to be
informed beforehand as to what is to be taken up
and the general situation of things that are to be
discussed. Therefore, I think it will make possible
the more intelligent conducting of the meeting,
after we do get here. I am in favor of it, although
it won’t save time.
Dr. Abbott J. Fuller of Pemaquid: When I was
a delegate, I came here absolutely unprepared, not
knowing what was going on. I am in favor of Dr.
Smith’s proposal because the Councilor will visit
each county society once a year.
Therefore, I would make a motion that Dr.
Smith’s original idea that the Councilor of the Dis-
trict meet with the President and Secretary and
the delegates and alternates of the county society
and discuss proposed business before the regular
meeting of the Maine Medical Association, be car-
ried out.
Dr. Stephen A. Cobb: They have really got to
go farther than that; they have got to have, not
only the meeting, but they have got to get this
thing down so that we won’t be spending too much
time, too many hours, in the House of Delegates.
I am in favor of the general proposition.
So that we have got to be sure that we don’t
take up too much time at the House of Delegates’
meetings in discussions.
A Member: I talked with Dr. Smith about this;
I thought that was his point. We take up too much
time listening to these reports, when they can be
Nineteen Hundred and Forty-twa— December
published in the Joi rxal. Nobody can criticize the
efficiency and intelligent handling of these meet-
ings at the present time; they are run like a steam-
roller, but not on purpose; it is just that they are
intelligently handled.
Presidext P. L. B. Ebbett of Houlton: Some one
spoke about a regular visit of the Councilor to the
different societies. I should like to say that many
of these matters do not come up before the Coun-
cilor has made his regular visit.
Of course, the different societies will have to be
instructed as to what was going to come up, before
they could discuss these things. That probably
would be late in the year, before they would know
all that was going to come up.
Cn.uRiiAx Stevexs: I wish to say, for the bene-
fit of those members of the House of Delegates who
may not know, that the matters brought up by Dr.
Nickerson were really brought up yesterday by the
Council meeting, and I think we can all agree that
that has taken plenty of time. If you are going to
consider that these things must be before the
Council first, then the Council should have a much
earlier meeting.
However, there is a motion before the House,
which w’as made by Dr. Fuller and which was
seconded.
Those who are in favor of the motion will please
signify in the usual manner. Those opposed?
283
The motion was carried, with two dissenting
votes.
Chatrmax Stevexs: Is there any further busi-
ness to come before the meeting?
Dr. Adam P. Leightox: I am just an interloper
in the audience here, not being a delegate. But,
there is one matter I should like to speak about
and ask you for your aid.
As Secretary of the State Board of Registration
in Medicine, I am asked daily to place men or to
suggest places in which to practice.
Now, it is not within my province to write let-
ters and try to get doctors to settle in Maine or at
least in certain parts of Maine, and, between you
and me, I don’t know the places for them to go to.
I have placed dozens of men in separate communi-
ties, where I knew men had died or moved away;
but, it is now getting to the bothersome stage for
me.
I write 300, 400 and 500 letters a year to doctors
coming in to Maine, and wanting to go in the
smaller communities.
Could not the Councilor of each District tell
your Secretary about the places where doctors are
needed so that I might refer them to the Secretary,
even though I know he has plenty to do. The thing
is really getting too much for me. and I keep
writing more and more letters.
Pause at the familiar red cooler for ice-cold Coca-Cola. Its life, sparkle
and delicious taste will give you the real meaning of refreshme^it.
284
I would appreciate it if something could be done
along that line to help the Board of Registration
in Medicine.
Chairman Stevens: That is a very fine sugges-
tion.
Dr. Frank A. Smith: This is very important.
A short time ago, we lost a good man who might
have come into the State. We needed him. But,
Dr. Leighton did all he could, I know.
As time goes on, each one of us is going to find
it harder and harder to do the work, and if we can
get men here, by having smooth machinery work-
ing by which they can know at once an acceptable
place to practice where they are most needed, it
would be of great help.
I move that the Council take this matter up and
consider it very seriously.
Dr. Charles W. Kinghobn of Kittery: I think
something definite should be done about that.
Within the last three months, a man contacted me
and wanted to practice. I wrote to everybody, in-
cluding the State Department, and the answer to
me was that there weren’t any vacancies in the
State of Maine.
The Journal of the Maine Medical Association
Dr. Carl E. Richards: I wish to second the mo-
tion of Dr. Smith’s. Five years ago, I came to
Maine to the convention looking for a place to
practice in Maine. I went through all this red tape
of trying to find a place. After the convention was
over, I toured the State and found one very accept-
able place. I am sure if the war doesn’t prohibit
it, there will be others up here in the same pre-
dicament. With the proper help, I know they can
find places.
Chairman Stevens: Is there any further discus-
sion on this motion? If not, all those who are in
favor of the motion will please signify in the usual
manner.
Upon a hand vote, the motion was carried.
Chairman Stevens: Is there any further busi-
ness to come before the meeting? If not, a motion
is in order to adjourn.
A Member: I move that we adjourn.
This motion was duly seconded and was carried.
(Whereupon, the Second Meeting of the House
of Delegates was adjourned at 6.50 o’clock in the
afternoon.)
Pay Your 1943 State and County Dues Promptly
to Your County Secretary
Disabilities occasioned by war are covered in full.
86c out of each $i.U0 gross income
used for members benefit
PHYSICIANS CASUALTY ASSOCIATION
PHYSICIANS HEALTH ASSOCIATION
Hospital, Accident, Sickness
INSURANCE
For ethical practitioners exclusively
(57,000 Policies in Force)
LIBERAL HOSPITAL EXPENSE
COVERAGE
For
$10.00
per year
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For
$32.00
per year
$10,000.00 ACCIDENTAL DEATH
For
$64.00
per year
$60.00 weekly indemnity, accident and sickness
$16,000.00 ACCIDENTAL DEATH
For
$96.00
per year
$76.00 weekly indemnity, accident and sickness
40 years wider the same management
$2,220,000.00 INVESTED ASSETS
$10,750,000.00 PAID FOR CLAIMS
$200,000 deposited with State of Nebraska for pro-
tection of our members.
Disability need not be incurred in line of duty — benefits
from the beginning day of disability.
Send for applications, Doctor, to
400 First National Bank Building Omaha, Nebraska
A OIlirtBttttaa (grrrttttg
To Our Valued Patrons
After seventy-five years of service to
hospitals and doctors, we wish to
express our appreciation for all past
favors and shall look forward to a
mutually pleasant business relation-
ship in the future.
★
GEO. C. FRYE CO.
116 FREE STREET
PORTLAND, - MAINE
VOLUME THIRTY-THREE
THE JOURNAL
of the
MAINE MEDICAL ASSOCIATION
EDITORIAL BOARD
Maine Medical Association
Frederick R. Carter, Portland, Chairman Roland B. Moore, Portland
C. Harold Jameson, Rockland E. H. Risley, Waterville
Maine Hospital Association
Allan Craig, Bangor Joelle Hiebert, Lewiston
W. J. Renwick, Auburn
S. R. Webber, Calais
286
The Journal of the Maine Medical Association
Officers of the Maine Medical Association
1942-1943
President, Carl H. Stevens, Belfast
President-Elect, Stephen A. Cobb, Sanford
OFFICERS
Secretary-Treasurer, Frederick R. Carter, Portland
Assistant Secretary, Esther M. Kennard, Portland
COUNCILORS AND DISTRICTS
Cumberland, York
Androscoggin, Franklin, Oxford
Knox, Lincoln, Sagadahoc
Kennebec, Somerset, Waldo
Hancock, Washington
Aroostook, Penobscot, Piscataquis
E. Eugene Holt, Portland,
Currier C. Weymouth, Farmington,
C. Harold Jameson, Rockland,
John O. Piper, Waterville,
Oscar F. Larson, Machias,
Norman H. Nickerson, Greenville,
First District,
Second District,
Third District,
Fourth District,
Fifth District,
Sixth District,
Scientific
Eugene E. O’Donnell, Portland
Legislative
Frederick R. Carter, Portland
Medical Advisory
Carl M. Robinson, Portland
CHAIRMEN OF COMMITTEES
Medical Education and Hospitals
Adam P. Leighton, Portland
Public Relations
R. V. N. Bliss, Bluehill
Social Hygiene
Richard P. Jones, Belfast
1945
1945
1944
1944
1943
1943
Cancer
Mortimer Warren, Portland
Publicity
Frederick R. Carter, Portland
Financial Advisory Committee
George L. Pratt, Farmington
INDEX
Volume Thirty-three
Articles
A
PAGE
Abdomen, Laceration of, with Ectopia Viscera
(Bisson, N.) 116
Appendicitis, Acute, Mortality of (Brinkman, Har-
ry) 180
Arterial Hypertension, Newer Knowledge Concern-
ing (Ellis, Laurence B. ) 263
B
Bingham Associates Fund in Maine, The Work of
(Pratt, Joseph H. ) 243
Blood Sedimentation : Ciinical Value of Rate of
(Based on Study of 500 Unselected Patients)
(Blaisdell, E. R., and Smith, K. E. ) 72
Blood and Plasma Banks, State of Maine (Gottlieb,
Julius, Clapperton, Gilbert, and Emond, Bertha
W.) 81-151
Burns, Treatment of (Aldrich, R, H, ) 21
C
Cancer, Control in Maine, 1942 (Warren, Mortimer,
and Kobes, Herbert R, ) 79
Cancer, Stomach (Brailey, Allen G, ) 229
Chemotherapy : More Common Chemical Values,
their Clinical Interpretations, Including Chem-
otherapeutic Levels (Gottlieb, Julius, and Cha-
pin, Milan) 10
E
Esophageal Diverticulum, Pulmonary Suppuration
Secondary to (Hill, Frederick T,) 99
F
Freudian Theories (Newman,. Israel ) 271
H
Henoch’s Idiopathic Purpura (Hadley, Flenry G, ) 184
History :
An Old-Fashioned Medical School (Tobie, Walter
E.) 175
Looking Back Fifty Years (Sincock, W^, Edgar) 31
Hospital, Records ; — The Problem of Every (Fisher,
Pearl R, ) 113
I*
Pregnancy, Toxemias of (Sewall, C. W^esley) 43
Presidential Addresses :
P. L. B, Ebbett, President, Maine Medical Asso-
ciation, 1941-42 149
Allan Craig, President, Maine Hospital Associa-
tion, 1940-41 9
R
Rhinology and Otology (Berrie, Lloyd H, ) 158
S
Selective Service, Medical and Psychiatric Prob-
lems of (Currier, Donald E, ) 65
Slipping Rib Cartilage Syndrome, with Report of
Cases (Holmes, John F, ) 89
Splint, for First Aid Care of Injured Arm or Leg
(Parcher, Arthur FI,) 250
U
Ulna, Subluxation of Distal End (Ruhlin, C. W. ).,,. 197
Authors
Aldrich, R, H,, Boston, Mass 21
Berrie, Lloyd H,, Caribou, Maine 158
Bisson, N,, Waterville, Maine 116
Blai.«dell, Elton R,, Portland, Maine 72
Brailey, Allen G., Brookline, Mass 229
Brinkman, Harry, Wilton, Maine 51-180
Chapin, Milan, Lewiston, Maine 10
Clapperton, Gilbert, Lewiston, Maine 81-151
Craig, Allan, Bangor, Maine 9
Currier, Donald E,, Lieut, Col. M. C., Selective
Service, Mass 65
Dameshek, William B., Boston, Mass 1-221
Eade, Arthur W. (General Agent, Commercial
Casualty Insurance Co.) 56
Ebbett, P. L. B., Houlton, Maine 149
Ellis, Laurence B., Boston, Mass 263
Emond, Bertha W., R. N., Lewiston, Maine 151
I
Insurance, Accident and Health, Things to Know
About (Eade, Arthur AV. ) 56
Intestinal Obstruction, Acute ; Important Points in
Diagnosis and Treatment (Brinkman, Harry) 5i
E
Laceration of the Abdomen with Ectopia Viscera
(Bisson, N. ) 116
i\I
Medicine :
Medical Queries Answered (1) (Karsner, How-
ard T., Pratt, Joseph II., Dameshek, William
B., and Gottlieb, .lulius) 1
Medical Queries Answered (2) (Proger, Samuel
H., Dameshek, AVilliam B., MacMahon, Harold
E., and Gottlieb. .lulius) 221
Medicine and Air Supremacy (Fulton, John F. ) 201
Fisher, Pearl R., R. N., Waterville, Maine 113
Pulton, John F., New Haven, Conn 201
Gottlieb, Julius, Lewiston, Maine 1-10-81-151-221
Hadley, Henry G.. AA^ashington, D. C 184
Flill, Frederick T.. AA^aterville, Maine 99
Holmes, John F., Manchester, N. H 89
Karsner, Howard T., Cleveland. Ohio 1
Kobes, Herbert R., Augusta, Maine 79
MacMahon, Harold E., Boston, Mass 221
Newman, Israel, Augusta, Maine 271
Parcher, Arthur H., Flllsworth, Maine 250
Pratt, Joseph H., Boston, Mass 1-243
Proger, Samuel H., Boston, Mass 221
Ruhlin, C. AV., Bangor, Maine 197
Nineteen Hundred and Forty-two — December
287
Sewall, C. Wesley, Boston, Mass 43
Sincock, W. Edgar, Caribou. Maine 31
Smith, Kenneth B., Portland, Maine 72
Tobie, Walter E., Portland, Maine 175
Warren, Mortimer, Portland, Maine 79
Editorials
'* PAGE
American Medical Association 1943 Meeting Can-
celled 252
An Opportunity to Serve 102
Annual Dues 58
Annual Meeting (1942) 119
Appointment and Promotion of Doctors in Service 232
Civilian Medical Care 276
Concerning Proposal to Tax Hospitals and Colleges 119
Industrial Health 211
Maine Medical Association, Annual Session, 1943 .... 252
Medical Officers Needed 164
Members in Military Service 211
National Cancer Control Month 84
Ninetieth Annual Session (1942) 58
Our Friends the Exhibitors 120
President-elect, The 164
Proceedings at the Ninetieth Annual Session (1942) 187
The Expected Has Happened 12
The Price of Peace 36
To Each A Duty 187
With Sincere Thanks 12
General
A
American Medical Association, Platform of ....
PAGE
210-270
B
Blood Plasma Banks 59
Book RevicAVS :
A Manual of Bandaging, Strapping and Splint-
ing 108
Abdominal and Genito-Urinary Injuries 257
Annual Reprint of Reports of Council on Phar-
macy and Chemistry of the American Medical
Association for 1940 64
Body Mechanics in Health and Disease Ill
Cardiac Clinics Ill
Chinese Lessons to Western Medicine 112
Clinical Immunology, Biotherapy and Chemo-
therapy in the Diagnosis, Prevention and Treat-
ment of Disease 108
Diseases of Women 194
From Cretin to Genius 108
Functional Pathology 195
Handbook of Communicable Diseases 112
Immunity Against Animal Parasites Ill
Immunology 257
Manual of Standard Practice of Plastic and Max-
illofacial Surgery 194
Medical Clinics of North America 194
Methods of Treatment in Postencephalitic Park-
insonism 194
Microbes Which Help or Destroy Us 112
Necropsy — A Guide for Students of Anatomic
Pathology 108
Neuroanatomy 195
New and Non-Official Remedies, 1941 64
Synopsis of Applied Pathological Chemistry 64
The Care of the Aged — “Geriatrics” 237
The Complete Weight Reducer 108
The Treatment of Infantile Paralysis in the
Acute Stage 193
C
Civilian Medical Defense :
Civilian Defense — Emergency Base Hospitals .. 25 3
Consultants on OCD Blood and Plasma Programs 188
Emergency Medical Service — State of Maine .... 37
New Appointments 188
State Hospital Officers Appointed 188
County Medical Societies;
Members in Miiitary Service. .141-172-213-236-256-279
New Members 19-41-62-87-106-172-190
News and Notes :
Aroostook 86-190-279
Cumberiand 18-40-86-105-171
Frankiin 18-122-214
Kennebec 18-61-86-106-122-235
Knox 19-86-255-279
Oxford 171-255
Penobscot 19-40-87-106-122-255-279
Piscataquis 19-62-171-235
Somerset 122-279
York
40-106-256
Defense Savings
D
103
H
Home Study Courses, Maine Medical Association. .189-261
I
Industrial Health :
Program — Maine Safety and Industrial Health
Conference
215
Locke, Herbert E., Attorney, Honorary Member .... 167
Maine Board of Registration of Medicine 19-107-^36
Maine Hospital Unit (67th General Hobital),
Members of iqi
Maine Medical Association:
Annual Session, 1942 (90th) :
Commercial Exhibits iqo
Delegates 137
Election of Officers :
Councilors (1st, 2nd, and 3rd Districts) 259
Fifty-Year Service Medals i 136
House of Delegates, Proceedings at :
First Meeting 2I6
Second Meeting !!!..'.!!!!!!!!!!! 258
Ninetieth Annual Session (C. C. Weyrriouth'
Chairman, Scientific Committee) ’ 85
Officers Elected irq
Program ^3^
Program in Brief 109
Budget, 1942-43 217
Committee Reports :
Nominating (Standing and Speciai Commit-
tees, 1942-1943) i6g
Special Committees (1941-1942):
Conservation of Vision 242
Financial Advisory 260
Graduate Education 128
Hospital and Medical Care, Survey 129-240
Industrial Health 261
Investigate Collection Agencies 127
Standing Committees (1941-1942) :
Cancer ]^26
Medical Education and Hospitals 259
Public Relations 126
Publicity I'"’' 240
Social Hygiene ’ 240
Council Reports :
First District (Stephen A. Cobb) 123
Second District (Eugene M. McCarty) 124
Third District (C. Harold Jameson) 125
Fourth District (John O. Piper) 125
Fifth District (Oscar F. Larson) 125
Sixth District (Norman H. Nickerson) 126
Delegates ;
American Medical Association 137
New England States 137
Delegates’ Reports :
American Medical Association, 19 42 (Thomas
A. Foster) 217
Massachusetts, 1942 (Forrest B. Ames) 238
New Hampshire. 1942 (Carl E. Richards) 239
Rhode Island, 1942 (Joseph E. Porter) 239
Necrologist Report “In Memoriam” 129
President, 1941-1942, P. L. B. Ebbett, Houlton .... 117
President, 1942-1943, Carl H. Stevens, Belfast .... 160
President-elect, Stephen A. Cobb. Sanford 164
President’s Page: P. L. B. Ebbett 118
Roster, Maine Medical Association (Officers,
Members in Military Service, Members) 141
Secretary’s Report 130
Treasurer’s Report 130
Maine Public Health Association (The 15th Early
Diagnosis Campaign for the Prevention of
Tuberculosis) 83
Maternal and Child Welfare :
Committee on 212
Prenatal Care 233-253
Breast Feeding 277
Medico-Legal Society of Maine :
Annual Meeting, 1942 215
Program no
N
Notices 19-41-63-107-110-135-172-191-215-236
P
Procurement and Assignment of Physicians :
A Cali to the Medical Profession 14
Office of War Information — War Manpower
Commission 252
Recommendations to All Physicians with Refer-
ence to the National Emergency 34
The Procurement of Physicians 165
Necrologies
PAGE
Allen, Adelbert Beeman, Richmond (1879-1942) .... 256
Anderson, William Deiue, Portland (1881-1942) .... 170
Best, Herbert Huestis, West Pembroke (1871-1942) 256
Bunker, Luther Grow, Waterville (1868-1942) 281
Cox, James Francis, Bangor (1877-1942) 60
Dunn, Bertrand Francis, Portland (1844-1942) 104
Hendee, Walter Whitman, Vassalboro (1889-1942) 39
O’Connell, George B., Lewiston (1877-1941) 39
Owen, Herbert A., Buxton (1871-1942) 170
Pelletier, Anthony D. J., Lewiston (1906-1942) 236
Ross, Prank A., South Berwick (1873-1942) 281
Sylvester, Charles Bradford, Portland (1865-1941) 17
Ward, Parker Myles, Houlton (1873-1942) 281
Wiseman, Robert James, Lewiston (1871-1942) .... 281
XI
To Physicians joining the
ARMED FORCES
We render a complete service on your accounts
receivable, notifying patients of your entry in
U. S. armed forces and tactfully collecting what-
ever amounts are due,
Write for details.
CRANE DISCOUNT CORPORATION
230 W. 41st St. New York
PROMPT DELIVERY
ON ALL SURGICAL AND
CORRECTIVE SUPPORTS
SPECIALS MADE AS YOU WANT THEM
If your source of supply has stopped
why not try us.
ELMER N. BLACKWELL
Surgical Appliance Specialist
207 Strand Building Portland, Maine
Prentiss Loring, Son & Co.
465 Congress St., Rooms 406-407, Portland, Me.
General Insurance
SPECIALIZING IN
Physicians' and Surgeons'
Liability Insurance
PHONE 3-6161
Philip Q. Loring, President
BRACES
Orthopedic braces, corsets, trusses,
celluloid and leather appliances
MADE TO ORDER
Prompt and efficient service.
THE CHILDREN'S HOSPITAL
68 HIGH STREET PORTLAND, MAINE
Write or Tel. Superintendent.
HOSPITAL PHARMACY, Inc.
Christopher Longryorth, Reg. Ph.
798 - 800 Congress Street Portland, Maine
Bramhall Square
BIOLOGICALS
SERUMS
VACCINES
Professional
Prescription
Druggists
Service to the Medical Profession
Mail Orders Given Prompt Attention
Index to Advertisers
Blackwell, Elmer N XI
Camel Cigarettes xil
Children’s Hospital, The xi
Coca-Cola 283
Crane Discount Corporation XI
Frye Company, Geo. C 284
Gay Private Hospital VI
Holland-Rantos Co. , Inc XIII
Hood’s IX
Hospital Pharmacy, Inc XI
Jones’ Private Sanitarium VI
Leighton’s Hospital, Dr VI
Lilly & Company, Eli X
Mead Johnson & Company XV
Medical Auditing Counsel 278
Oakhurst Dairy v
Parke, Davis & Company VII
Petrogalar n
Philip Morris & Co XIV
Physicians Casualty Association 284
Prentiss Loring, Son & Co XI
Squibb & Son, E. R VIII
State Street Hospital VI
Winthrop Chemical Co., Inc Ill
Zemmer Company, The 278
Patronize Your Advertisers
'iL
5«,
i
..
-'• ' H' ,
I-
■- '•• ,: -t- '
* '
I v; •
29865
^Jalns medical association journal.
V. 32-35, 19^i-Zf2
29865
Maine medical association journal.
V. 32-33, 1941-^2
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